Ch. 7 - The Nurse-Client Relationship

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

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

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

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

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

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

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 She appears distant and withdrawn.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

congruent communication

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

develop good communication skills

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

disagreeing

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

downcast eyes

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

orientation phase

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

the client's culture

What is an example of positive body language?

tilt of head

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

to assist the client to identify and achieve goals

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

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

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

working phase

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

working phase

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

neutral

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

open-ended question

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

orientation phase

The term metacommunication is best defined as:

interpersonal bridge between verbal and nonverbal communication

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

introducing oneself to the client by name

A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question?

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

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

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

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

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

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

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

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

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

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

"Has someone taught you how to take them?"

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

"Have you ever thought of laser surgery?"

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

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

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

"Just take your time. I am listening."

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

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

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

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

A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask:

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

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

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

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

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

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

A nurse who easily developed a rapport with clients.

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

allow the client to set the pace.

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

an audiologist

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

analysis

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

be silent and allow the client to continue speaking when ready

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

belittling

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

eliminate as many distractions as possible.

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

empathic

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

empathy

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

encouraging elaboration

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

examine goals of the relationship to determine whether they were achieved

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

facial expressions

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

false reassurance

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

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

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

guilt inducement or approval/disapproval

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

medical terminology

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

message

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

mutual agreement that the client's health problem has improved

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

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

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

speak directly to the client