Ch 4 B

A nurse is caring for a family with apparent language barrier. The nurse is preparing to discharge the patient who has been recently started on insulin and just learning to administer the medication and follow the dietary regime. Which of the following statements by the nurse reflects an understanding of communication in this context? 1. "I know this is a great deal of information to learn as you prepare for Mr. H to return home. If it's okay with you, I will come back later and we can review the information again." 2. "You probably have many questions. But they will get answered as you read these materials." 3. "Families have different ways of approaching the chronic disease of diabetes, but it is important for your family to understand the right way to approach this disease." 4. "I know it is difficult for Mr. H to accept this diagnosis, but it needs to be his disease to manage, rather than depend on you as his family."

1. "I know this is a great deal of information to learn as you prepare for Mr. H to return home. If it's okay with you, I will come back later and we can review the information again."

The Juarez family includes Maria, age 76, Juan, age 72, and three adult children. Maria has been managing a diagnosis of heart failure for approximately 10 years. Documentation suggests the family has had a great deal of stress with recent hospitalizations and caregiving in their home. The adult children voice their concerns about Maria's decision to complete an advanced directive. Which of the following demonstrate an insufficient understanding of family-focused nursing care and communication? 1. A nurse should make a statement such as, "Your family has had a great deal of distress lately; why don't you just let Maria make her own decisions." 2. A nurse's questioning techniques may help identify the family's beliefs and understandings about advanced directives. 3. A nurse should make a statement such as, "Your family has done a good job of caring for each other during this lengthy illness." 4. A nurse should attempt to clarify misunderstandings and share accurate information about the health status of the patient.

1. A nurse should make a statement such as, "Your family has had a great deal of distress lately; why don't you just let Maria make her own decisions."

Motivational interviewing techniques reflects which of the following premises? 1. Asking and listening are core communication skills needed when using motivational interviewing techniques. 2. This type of communication relies on the nurse's identification of the behavior needing to be changed. 3. This type of communication requires a nurse who can be directive and clear. 4. This type of communication is best used with an individual approach, rather than a family.

1. Asking and listening are core communication skills needed when using motivational interviewing techniques.

Which of the following is the best rationale for a nurse to spend time communicating with a family member of a hospitalized patient? 1. The nurse often has information that needs to be shared with a family member who is a primary social structure caring for an individual. 2. A nurse's communication can supports the nurse's position of power in the health-care system caring for an individual. 3. Communication with family members is critical to increase a nurse's satisfaction with the role. 4. Nurses use communication to develop an efficient interprofessional team that exchanges information.

1. The nurse often has information that needs to be shared with a family member who is a primary social structure caring for an individual.

Effective communication can assist a nurse to achieve which of the following desired health outcomes? 1. Readmissions with chronic disease exacerbations. 2. A nurse-individual-family relationship that supports quality nursing care. 3. Improved written documentation of errors in nursing. 4. Decrease in time spent communicating with difficult families.

2. A nurse-individual-family relationship that supports quality nursing care.

Which of the following statements describe accurate information about family-focused communication? A nurse's communication with a family: 1. Usually focuses on the individual family member with an illness. 2. Usually begins with a nurse sharing personal information. 3. Aims to develop a caring relationship that sees the individual and family as the unit of care. 4. Most often requires a nurse to determine the direction for family-focused communication.

3. Aims to develop a caring relationship that sees the individual and family as the unit of care.

Which of the following factors of a health-care system foster effective family-focused communication? 1. An environment that uses complex technology. 2. A nurse's stance that health-care providers maintain power in a relationship. 3. Educational materials that consider the health literacy of families. 4. A family's fears and anxiety about an individual member's illness.

3. Educational materials that consider the health literacy of families.

A nurse is caring for a male who has been informed of a prognosis of only several months before death. He wants to return to his home with hospice care. He has a wife and two daughters who do not support this decision. Which of the following communication principles should guide the nurse during this family situation? 1. A nurse guides families by staying focused solely on the patient's needs and wishes. 2. Families need to be informed that they are unable to provide the quality care needed in the home. 3. Exploring the family's beliefs about hospice, death, and their role can help families make decisions. 4. Helping family members understand the benefits of a patient dying at home produces the best outcomes.

3. Exploring the family's beliefs about hospice, death, and their role can help families make decisions.

The nurse is beginning a shift caring for a 26-year-old adult female who has just been admitted to the critical care area of a hospital with a pneumonia and respiratory failure. The nurse is told that the patient's parents are anxiously sitting in the waiting room. Which of the following statements best reflect a nurse's understanding of the communication needs of the parents? 1. "I will hurry with my assessment of your daughter so you can spend time with her after I leave." 2. "Why don't you go have a cup of coffee while I assess your daughter?" 3. "Since your daughter is an adult, I really can't share any information with you about her condition." 4. "All of this is probably frightening for you. Would you like to come with me into the room so I can explain equipment and information to you while I care for your daughter?"

4. "All of this is probably frightening for you. Would you like to come with me into the room so I can explain equipment and information to you while I care for your daughter?"

Julie is a 42-year-old wife and mother who has recently experienced a mastectomy for breast cancer. The nurse enters the room to check vital signs and sees tears in the eyes of Julie and her husband. Which of the following statements by the nurse reflect accurate understanding of approaches to communication in a therapeutic relationship? 1. "I know this is a difficult time for you and your family. It is probably best if we wait and talk about your concerns when you a little stronger." 2. "I think it will be helpful if you both remain hopeful and stay focused on the positive." 3. "I know this is a stressful time for you; would you like to visit with the chaplain?" 4. "You seem to be troubled, which is understandable. In what ways can I be the most helpful to you at this time?"

4. "You seem to be troubled, which is understandable. In what ways can I be the most helpful to you at this time?"

Which of the following reflect inaccurate assumptions of family-focused care? 1. Communication in a family and health-care setting can influence health. 2. Effective therapeutic communication is at the core of family-focused care. 3. Nurses can facilitate communication among family members to support family health. 4. Family members can be expected to reach out to nurses when they need information.

4. Family members can be expected to reach out to nurses when they need information.

A nurse is visiting a patient who has been discharged to home for a follow-up evaluation. The patient was diagnosed with diabetes many years ago. She has been hospitalized multiple times with infections and renal insufficiency. She now needs dialysis on a regular basis. Which of the following actions would support a therapeutic relationship between the nurse and family? 1. The nurse needs to limit the time given to the family to tell their story to stay focused on the patient. 2. The wound care and weight assessments are the priorities during this visit. 3. Using linear questioning techniques will help the family share their understandings of the situation. 4. Spending time assessing the patient's symptoms and the family's experiences will produce best outcomes.

4. Spending time assessing the patient's symptoms and the family's experiences will produce best outcomes.