Chapter 7 the nurse client relationship

15. A nurse who has been practicing for three decades has seen significant changes in the roles that clients are expected to perform in the course of their care. Which of the following is a role that clients are normally expected to perform while they are receiving care? A) Bring a high level of knowledge about their disease or health problem B) Avoid consuming an inordinate amount of caregivers' time C) Participate actively in the planning and execution of their care D) Defer to the nurse's knowledge and authority

Ans: C Feedback: Clients are generally expected to participate in their care in an active way. A passive and deferent demeanor is not encouraged, though cooperation and adherence to treatment are expected. Clients should not be made to feel guilty for requiring time and attention from care providers. Some clients are highly knowledgeable about their health problems, but this is not necessarily an expectation of all clients.

12. A nurse is asking a client health-related questions during a medical assessment. The client has developed lesions on the skin and warts around the mouth. Which of the following factors affect oral communication? A) Literacy B) Time of day C) The nurse's age D) Client's lifestyle

Ans: A Feedback: Factors affecting oral communication between the client and the nurse include attention and concentration; language compatibility; verbal skills; hearing and visual acuity; motor functions involving the throat, tongue, and teeth; sensory distractions; interpersonal attitudes; literacy; and cultural similarities. Time of day, the nurse's age, and the client's lifestyle do not affect communication as significantly.

18. A nursing student is conducting a client interview in order to determine the client's health history. The student's instructor observes that the student frequently twists her hair with her fingers while asking the client questions. What is the most plausible meaning of the student's nonverbal communication? A) The student feels insecure during the interview B) The student is unconsciously conveying authority C) The student is unsure how to interpret the client's responses D) The student feels superior to the client in some way

Ans: A Feedback: If the nurse plays with his or her hair during a client interaction, this can communicate insecurity. Superiority or confusion is less likely to underlie this form of nonverbal communication.

17. Through experience, a nurse has found that the judicious application of affective touch can benefit clients in certain circumstances. A) An elderly client who has just learned that her husband has been diagnosed with Alzheimer disease B) A man whose fractured tibia is being set by the cast team at the bedside C) A woman who is being extubated in the postanesthetic recovery unit after surgery D) A client in his early twenties who has a history of schizophrenia and who is experiencing delusions

Ans: A Feedback: The appropriate use of affective touch is highly subjective and situation dependent. However, clients who are older and who are distraught may be open to the nurse's use of affective touch. A client who is delusional or a person who is partially anesthetized would not benefit from affective touch. Clients who are uncomfortable may benefit from affective touch, but clients who are undergoing acutely painful procedures may not appreciate touch.

11. A nurse is caring for a terminally ill client whose death is imminent. The nurse has developed a close relationship with the family. Which of the following is the most appropriate intervention? A) Encourage family discussions of feelings. B) Make decisions for the family in difficult situations. C) Remain with the family but maintain silence. D) Tell the family to leave the client alone.

Ans: A Feedback: The nurse should facilitate open and effective communication among those threatened by the loss of a family member. The nurse should abstain from making decisions on the family's behalf. Inappropriate silence may generate anxiety in the family members, so the nurse should not remain silent. It is inappropriate to tell the family to leave the client alone when death is imminent.

8. A client reports to the primary health care facility with complaints of chest pain. After the investigations and initial treatment, the client anxiously inquires if he had a heart attack. What should be the nurse's reply? A) "The physician wants to monitor you and control your pain." B) "Yes, you had a heart attack; this is why you are here with us." C) "Yes, you had a heart attack, but the damage is very minimal." D) "No; we can assure you that you will not have a heart attack."

Ans: A Feedback: The nurse should give true information to the client. Stating that the physician wants to monitor the client and control his pain is true information. The nurse telling the client that he had a heart attack may increase his anxiety. Assuring the client that he will never have a heart attack is also an inappropriate statement because no one can ensure against a disease condition.

6. A nurse pays a house visit to a client who is on total parenteral nutrition. The client expresses that he misses enjoying food with his family. What is the most appropriate response by the nurse? A) "Tell me more about how it feels to eat with your family." B) "You can sit with your family at meal times, even though you don't eat." C) "In a few weeks you may be allowed to eat a little; you may enjoy then." D) "I know that you must be missing your favorite foods."

Ans: A Feedback: The nurse should help the client to verbalize his feelings and cope with aspects of illness and treatment. Asking open-ended questions is most appropriate as the nurse encourages the client to express his feelings. The other options block communication and are not appropriate. Telling the client that he can sit with his family but avoid eating does not consider the client's feelings. Informing the client that he will be able to eat food in a few weeks changes the subject and stops communication. Stating that the client is missing his favorite dishes devalues the client's feelings.

2. A nurse is examining a 3-year-old child with conjunctivitis. During the examination, the child starts crying and refuses to sit still. Which of the following statements is appropriate for the nurse to tell the child? A) "Would you like to see my flashlight?" B) "Don't be scared, the light will not hurt you." C) "I know you are upset; we can do this later." D) "If you sit still, this will be over in no time."

Ans: A Feedback: Toddlers are scared of procedures. To decrease the fear, children should be actively involved. Asking the child if he or she wants to see the flashlight would be most appropriate, as it engages the child in an activity. The nurse telling the child not to get scared in fact teaches the child to fear the hurt, and therefore it is inappropriate. Postponing the procedure is also inappropriate. The nurse should not tell the child to sit still and the procedure will soon be completed, because it disregards the child's feelings.

13. A nurse and an elderly client with chronic back pain are in the working phase of the nurse-client relationship. Which of the following activities occur in the working phase? A) The client identifies one or more health problems. B) The nurse tries to avoid retarding the client's independence. C) The nurse is courteous and actively listens to the client. D) The nurse ensures that the client manages independently.

Ans: B Feedback: In the working phase of a nurse-client relationship, the nurse tries not to retard the client's independence, because doing too much for the client is as harmful as doing too little. In the introductory phase, the client identifies one or more health problems, and the nurse is courteous and actively listens to the client's problems to ensure that the relationship begins positively. In the terminating phase, the nurse ensures that the client manages independently and the client's health condition has improved.

4. A female client reports to her primary care physician with complaints of recent aggravated chest pain. The physician orders a cardiac stress test. The client tells the nurse that she does not want to take the test and feels she should instead continue with her current medication a little longer. Understanding that the client is anxious, what is the most appropriate response by the nurse? A) "Emergency equipment is always kept ready." B) "Tell me more about how you are feeling." C) "Don't you want to improve your health?" D) "Most people tolerate the procedure quite well."

Ans: B Feedback: The client may have been anxious due to fear and anxiety related to the stress test. The nurse should try to explore the client's feelings by letting her express her concerns. Asking the client open-ended questions is best because it expresses concern for the client and encourages the client to verbalize her feelings. Stating that emergency equipment is always kept ready evokes more fear and interrupts communication. Questioning whether the client wants to get well or that others have tolerated this procedure quite well is inappropriate.

A client is scheduled for thoracentesis, a painful procedure that is performed to drain fluid from the pleural space. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client? A) "I will be by your side throughout the procedure; the procedure will be painless if you don't move." B) "The needle causes pain when it goes in, but I will be by your side throughout and will help you hold your position." C) "The procedure may take only 2 to 3 minutes, so you might get through it by mentally counting up to 120." D) "You may feel uncomfortable when the needle goes in, but remember that the stakes for this are very high."

Ans: B Feedback: Thoracentesis is a painful procedure and it is important to sit still to avoid injuring the pleura. The nurse should reassure the client that he or she will be present during the procedure and help her throughout. The nurse should provide correct knowledge as well as reassurance. Likewise, the nurse should avoid giving false reassurance about the procedure being painless. Additionally, the nurse should normally abstain from stating facts that could scare the client. The nurse should not use an authoritarian approach.

10. A nurse is caring for a client with myasthenia gravis, and disease which affects the client's ability to speak. The client is having difficulty forming words and his tone is nasal. Which of the following is an effective communication strategy for this client? A) Engage the client in a lengthy discussion to strengthen his voice. B) Encourage the client to speak quickly while talking. C) Repeat what the client has said to verify the meaning. D) Nod continuously when the client is talking.

Ans: C Feedback: The client is having a problem forming words and has a nasal tone due to a nerve involvement that controls speech. For effective communication, the nurse could reflect and verify whatever the client says. The nurse should ask only those questions that can be answered in a yes or no form. Lengthy discussions may tire the client. Encouraging the client to speak quickly is inappropriate. Nodding continuously when the client is talking would not facilitate an effective communication strategy.

The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. Which of the following is the most appropriate response by the nurse to decrease the client's anxiety? A) "I will start an IV, which should not take much time." B) "I will start an IV with an 18 gauge needle." C) "I will start an IV that will add fluids directly to the blood stream." D) "I will start an IV, which should not cause you any pain."

Ans: C Feedback: The nurse should explain the procedure and its purpose. The nurse telling the client that it should not take much time does not convey the purpose of the procedure. It is unnecessary for the nurse to inform the client about the technical details of the catheter. Additionally, the nurse should not give false reassurance by telling the client that the procedure will not be painful.

7. A nurse visits a female victim of sexual assault for the fourth visit. The client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse? A) "We should move on from the strong feelings associated with this incident." B) "In reality, the rape did not occur yesterday; it has been over one month now." C) "Tell me more about the aspects that makes you feel as if it happened yesterday." D) "Can you do something to alleviate the fear of being assaulted again?"

Ans: C Feedback: The nurse should make statements that would facilitate an expression of feelings from the client. The nurse should encourage the client to express her fears and insecurity. This conveys that the nurse is there to provide support. The nurse should avoid giving an opinion and should in fact allow the client to hold on to the feelings; it is a nontherapeutic approach. Making the client realize that the rape occurred a month ago would block communication.

A nurse is caring for an elderly client. What strategy should the nurse include in order to facilitate effective communication? A) React only to the facts during conversation. B) React enthusiastically during conversation. C) Use active listening during communication. D) Use an authoritarian approach toward the client.

Ans: C Feedback: The nurse should use active listening while communicating with an elderly client because the client feels comfortable expressing his feelings. Reacting only to the facts may not indicate active listening. Also, reacting enthusiastically is not an effective strategy while communicating with an elderly client. Additionally, the authoritarian approach does not create an environment for exchange of feelings and stops communication.

A nurse finds that a client has infiltration around the IV access and that the device needs to be removed. What explanation should the nurse give to reduce the client's anxiety? A) "The infiltration is causing you pain and you will be very relieved when I remove the IV line." B) "You should relax and take deep breaths; the procedure is very minor and will be over soon." C) "I know that you are anxious, but removal will be painless and the IV location needs to be changed." D) "It will be a painless procedure and there is nothing to worry about; many clients do fine with this."

Ans: C Feedback: The nurse uses therapeutic communication by both acknowledging the client's anxiety and giving honest information that another IV line needs to be started. Telling the client that infiltration is causing pain that would be relieved when the IV line is removed does not address the client's anxiety and does not inform the client about restarting another IV line. Also, the nurse telling the client to take deep breaths, or saying that the procedure is very minor and will be over soon, does not consider the client's anxiety. Finally, telling the client that many clients experience this is generalizing to the client and is not appropriate.

16. A nurse is working with an adult client who has been admitted with hyperglycemia following a period of poor glycemic control. The nurse has many similarities to the client with regard to age, gender, and socioeconomic status but is careful to utilize therapeutic communication techniques rather than social communication. How does therapeutic communication differ from social communication? A) Therapeutic communication relies heavily on technical medical vocabulary while social communication uses colloquialisms. B) Therapeutic communication focuses primarily on problems while social communication addresses positive aspects of the client's life. C) Therapeutic communication focuses on the requirements of the nurse while social communication is more reciprocal. D) Therapeutic communication is focused on a particular goal while social communication is more superficial in content.

Ans: D Feedback: Social communication is superficial; it includes common courtesies and exchanges about general topics. Therapeutic verbal communication involves the use of words and gestures to accomplish a particular objective. This does not mean, however, that therapeutic communication depends heavily on technical vocabulary or is focused solely on problems. Therapeutic communication is focused on the needs of the client, not the nurse.

14. A nurse is working with a client who is in postoperative day 2 following a total knee replacement. The client has briefly mobilized using a wheeled walker and with the assistance of the physical therapist. However, the client is reluctant to progress further with mobilization for fear of injuring herself. In response to this, the nurse has liaised with the physical therapist to create a plan of care that creates specific goals for the client's mobility. In doing so, this nurse has exemplified what role? A) Nurse as educator B) Nurse as caregiver C) Nurse as delegator D) Nurse as collaborator

Ans: D Feedback: The nurse acts as a collaborator when he or she works with others to achieve a common goal. This is especially evident when the nurse works cooperatively with members of other health disciplines. This differs from delegation, in which tasks are assigned to other members of the care team. This nurse's actions are not indicative of the educator or caregiver roles.