Chapter 8: Communication
The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply. A) "Are you ready to get out of bed?" B) "What sorts of things do you do for fun?" C) "What plans do you have after you are discharged?" D) "Do you smoke cigarettes?" E) "Is there any chance you might be pregnant?" F) "Does it hurt when I touch you here?"
A) "Are you ready to get out of bed?" D) "Do you smoke cigarettes?" E) "Is there any chance you might be pregnant?" F) "Does it hurt when I touch you here?" The closed-ended question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed-ended questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. Closed-ended questions are often a barrier to effective communication. Asking what the client does for fun or what the client's future plans are facilitates communication between the client and the nurse. Reference: Chapter 8: Communication, p. 170.
A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse? A) "I am so sorry you are going through this. Can we talk?" B) "I know this is hard for you. Is there any way I can help?" C) "Sitting in the dark is not going to cure your cancer. Let's open the curtains." D) "Can you please tell me why you are crying?"
B) "I know this is hard for you. Is there any way I can help?" Explanation: Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. By retaining this quality, you can establish successful helping relationships without appearing cold or stern. The statement "I am so sorry you are going through this" demonstrates sympathy. Sympathy differs from empathy because it shifts the emphasis from the client to the nurse as the nurse shares feelings and personal concerns and projects them onto the client, limiting the ability to focus objectively on the client's needs. Asking about why the client is crying is part of information gathering but is not empathy. Stating that sitting in the dark will not cure cancer is an abrasive statement that may work against the nurse-client relationship. Reference: Chapter 8: Communication, p. 165.
The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client? A) "This is so sad and I feel so bad that you are in this situation." B) "It sounds as though you are most concerned about how your children will feel." C) "I am so sorry that I am crying with you when you need my support the most." D) "This just is not fair at all and I do not understand why this is happening to you."
B) "It sounds as though you are most concerned about how your children will feel." Explanation: The nurse is demonstrating empathy when reiterating what the client is saying. This helps the nurse become effective at providing for the client's emotional needs while maintaining detachment. The other responses indicate that the nurse is feeling sympathy for the client, which includes feeling as emotionally distraught as the client. While this may be an unavoidable response, it may not help the client move through the grieving process as effectively. Reference: Chapter 8: Communication, Empathy, p. 164.
Which is a skill appropriate to use in therapeutic communication? A) Control the tone of the voice to avoid hidden messages. B) Avoid the use of periods of silence. C) Use cliches to enhance a client's understanding of information. D) Be precise and inflexible regarding the intent of the conversation.
A) Control the tone of the voice to avoid hidden messages. Explanation: Conversation skills used in therapeutic communication include controlling the tone of one's voice so that exactly what is intended is conveyed and not any hidden message. Periods of silence have an important role in conversations because they allow for reflection. The nurse should avoid using cliches, and the conversation should be flexible. Reference: Chapter 8: Communication, p. 167.
Each facilitates a therapeutic nurse-client relationship except: A) closed-ended questions. B) rephrasing. C) active listening. D) reflection.
A) closed-ended questions. Explanation: Rephrasing, reflection, and active listening are essential for accurate assessment and interventions. Reference: Chapter 8: Communication, p. 170.
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? A) "I understand you have four kids; how many times have you actually been pregnant?" B) "All right, you have four children, is that correct?" C) "How old are your children?" D) "Were these term births?"
A) "I understand you have four kids; how many times have you actually been pregnant?" Explanation: The use of the clarifying question or comment allows the nurse to gain an understanding of a client's comment. In this scenario, the nurse is asking how many times the client has been pregnant. Gravida refers to the number of pregnancies, whereas para refers to the total number of live births. Confirming the client has four children is a form of validating what the client said. The age and/or term of the children does not clarify the original question asked by the nurse. Reference: Chapter 8: Communication, p. 170.
A client reports to a primary care health care provider with aggravated chest pain. The health care provider orders a stress test. The client tells the nurse that the client does not want to take the test and would prefer instead to continue taking medication a little longer. Understanding that the client is anxious, what is the most appropriate response by the nurse? A) "Tell me more about how you are feeling." B) "Don't you want to improve your health?" C) "Emergency equipment is always kept ready during stress tests." D) "Most people tolerate the procedure quite well."
A) "Tell me more about how you are feeling." Explanation: The client's desire to not undergo the stress test may be due to fear and anxiety related to the test. The nurse should try to explore the client's feelings by inviting the client to express them. Asking the client open-ended questions is best because it expresses concern for the client and encourages the client to verbalize feelings. Stating that emergency equipment is always kept ready would evoke more fear and interrupt communication. Questioning whether the client wants to get well or stating that others have tolerated this procedure quite well is inappropriate. Reference: Chapter 8: Communication, p. 168.
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: A) "What did your health care provider tell you about your need to be admitted?" B) "Are you allergic to any medications?" C) "Can you tell me the medications you take on a daily basis?" D) "Do you have an advanced directive or a living will?"
A) "What did your health care provider tell you about your need to be admitted?" Explanation: When obtaining a nursing history, use the open-ended question technique to allow the client a wide range of possible responses. The greatest advantage of this technique is that it prevents the client from giving a simple "yes" or "no" answer, which limits the client's response. The questions related to medication use, allergies, and an advanced directive are examples of closed communication, in which only one or a few words are required for an answer. Reference: Chapter 8: Communication, p. 170.
A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation? A) "What is your name?" B) "Is your name Evelyn?" C) "Are you in a hospital?" D) "Is today the first day of the month?"
A) "What is your name?" Explanation: Asking the client to state their name represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking closed-ended questions, which are answered with a simple yes or no response. The remaining responses are all closed-ended questions and therefore would not provide an accurate assessment of the client's orientation. Reference: Chapter 8: Communication, p. 163.
A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening? A) "You seem unsure. Tell me your concerns about your surgery." B) "I understand your confused, what do you think you should do?" C) "I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?" D) "You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure."
A) "You seem unsure. Tell me your concerns about your surgery." Explanation: To understand the client's perspective, the nurse uses therapeutic communication techniques to encourage verbal expression. The use of active listening facilitates therapeutic interactions. "You seem unsure" demonstrates that the nurse was actively listening and has decoded the content and feelings of the client. "Tell me your concerns about your surgery" is an open-ended statement which will allow the client to express themselves. Giving clients the opportunity to be heard helps them organize their thoughts and evaluate their situation more realistically. "I understand you are confused" and "I understand that you are not sure" are examples of rescue feelings on behalf of the nurse. Saying I understand implies the nurse has the knowledge to fix the problem, especially followed by an explorative statement. Asking the client what he or she thinks he or she should do or why the surgery is not needed will put the nurse in the position to judge the response. "Please let me know if you decide to postpone the surgery until you are no longer unsure" suggests that the client should postpone the surgery and is an example of giving advice. The nurse should not give opinions, attempt to sway a client's opinion, or avoid an uncomfortable discussion. Reference: Chapter 8: Communication, Assessment and Clinical Reasonin, p. 338.
What nursing care behavior by the nurse engenders a client's trust in the nurse? A) A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. B) A nurse tells the client, "Do not worry about the test, I have never cared for anyone that had problems with it." C) A nurse tells the client, "My shift will be over in 45 minutes, I will let the oncoming nurse know you have questions about tomorrow's test." D) A nurse answers the client's questions about an upcoming test while completing documentation in the EHR.
A) A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. Explanation: It is important to remember that helping relationships are professional relationships. Telling a client not to worry about the test because others have not had problems with it undermines trust by belittling the client's concerns. A nurse that answers the client's questions while documenting or defers the questions to the oncoming nurse gives the impression that the client's questions or concerns are not important. Answering the client's questions while making eye contact instils trust by showing that the nurse is competent to answer the questions and cares about the client in their care. Reference: Chapter 8: Communication, p. 151.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse? A) A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's. B) A nurse describes a client on Twitter by giving the room number rather than the name of the client. C) A nurse posts pictures of a client who accomplished a goal of losing 100 lb and later deletes the photo. D) A nurse describes a client on Twitter by giving the client's diagnosis rather than the client's name.
A) A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's. Explanation: A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse's and do not represent those of the employer. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly. Reference: Chapter 8: Communication, pp. 153-154.
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client? A) Approach the client with empathy and understanding and allow the client to share feelings without being judged. B) Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding. C) Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation. D) Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive.
A) Approach the client with empathy and understanding and allow the client to share feelings without being judged. Explanation: Rapport is a feeling of mutual trust between nurse and client. Kindness is the quality of being friendly, generous, and considerate. Active listening and the use of silence are communication techniques, but they do not necessarily develop mutual trust between the nurse and client. Reference: Chapter 8: Communication, Patient Interview, p. 350.
A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client? A) Arrange for a sign language interpreter when discussing treatment. B) Talk with the client's children to determine needs. C) Consult the oncology nurse specialist. D) Use a text-telephone device (TTD) for daily communication.
A) Arrange for a sign language interpreter when discussing treatment. Explanation: During the planning step of the nursing process the nurse develops and prioritizes an individualized plan of care in partnership with the client, family, and others as appropriate. The client with mental or physical limitations should be included in the plan as much as possible. A sign language interpreter allows the client to participate fully in the plan of care. Consulting with the client's children is not as beneficial because it places them in the difficult position of translating while experiencing the emotional strain of the parent's illness. A TTD line can assist in communication but is not as helpful as a medical interpreter. Consulting the oncology nurse specialist is not as helpful in communicating with this client as an interpreter. Reference: Chapter 8: Communication, p. 176
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication? A) Assess how the client would like to communicate B) Use facial and hand gestures C) Contact a person skilled in sign language D) Provide paper and pencil for written communication
A) Assess how the client would like to communicate Explanation: Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge. Reference: Chapter 8: Communication, p. 176.
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? A) Be silent and allow the client to continue speaking when ready. B) Smile and say, "Don't worry, I am sure the health care provider is doing a good job." C) Nod and say, "I agree. If I were you, I would get a new doctor." D) Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
A) Be silent and allow the client to continue speaking when ready. Explanation: When clients are angry or crying, the best nursing response is to remain nonjudgmental, allow them to express their emotions, and return later with a follow-up regarding their legitimate complaints. Therefore, staying silent and allowing the client to continue speaking when ready is the most appropriate response in this scenario. Giving false reassurance, agreeing, giving advice, or avoiding the subject are traps that block or hinder verbal communication. Reference: Chapter 8: Communication, p. 169.
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. What is a characteristic of empathy? A) Identifying with the client's feelings B) Experiencing feelings similar to those of the client C) Conveying genuine care to the client D) Caring for the client without negative judgment
A) Identifying with the client's feelings Explanation: Empathy is the ability to identify with client feelings. Congruence refers to feelings that match the expressions of the client. Positive regard means conveying genuine care to clients without passing any negative judgment on them. Reference: Chapter 8: Communication, p. 165.
The nurse cares for a client who is sharing a personal health story. Which behavior(s) demonstrates active listening? Select all that apply. A) The nurse paraphrases what the client has stated before generating a response. B) The nurse shares a personal story about experiences with hospitalization. C) The nurse observes the nonverbal behavior of the client as the client speaks. D) The nurse offers multiple solutions while the client is sharing a personal story. E) The nurse makes eye contact while the client is sharing a personal story.
A) The nurse paraphrases what the client has stated before generating a response. C) The nurse observes the nonverbal behavior of the client as the client speaks. E) The nurse makes eye contact while the client is sharing a personal story. Explanation: The use of active listening (demonstrating full attention to what is being said, hearing both the content being communicated and the unspoken message) facilitates therapeutic interactions. Giving clients the opportunity to be heard helps them organize their thoughts and evaluate their situations more realistically. By making eye contact, the nurse demonstrates full attention to what the client is sharing. Making observations of the client's nonverbal behavior as the client tells one's story attunes the nurse to personal feelings that may not be stated in the verbally communicated message. Paraphrasing is a skill associated with active listening because it allows the nurse to seek clarification to be certain the client is being understood correctly. Offering multiple solutions does not demonstrate active listening. Finding solutions is a collaborative act between the nurse and the client. It is not appropriate to share a personal story or offer a personal disclosure, because this can place the client in a psychologically unsafe situation or impose the feeling that the client needs to offer support to the nurse. Reference: Chapter 8: Communication, p. 172.
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? A) The working phase B) The introduction phase C) The orientation phase D) The termination phase
A) The working phase Explanation: There are three phases of a helping relationship: the orientation phase, the working phase, and the termination phase. The introduction phase is not a valid phase, yet the nurse introduces oneself during the orientation phase. The scenario defines characteristics of the working phase, during which the nurse and client work together to meet the client's physical and psychosocial needs. During the orientation phase, the nurse and client establish the tone and guidelines for the relationship . The termination phase occurs when the nurse and client acknowledge that they have met the goals of the initial agreement or that the client would be better served by another nurse or health care provider. Reference: Chapter 8: Communication, p. 163.
A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult: A) an audiologist. B) an ophthalmologist. C) a clinical psychologist. D) an optometrist.
A) an audiologist. Explanation: A nurse who suspects a speech, language, or hearing problem should refer the client to a speech-language pathologist or audiologist. A speech-language pathologist is a professional educated in the study of human communication, its development, and its disorders. An audiologist is a professional educated in the study of normal and impaired hearing. An ophthalmologist is a medical doctor who specializes in the treatment of eye disorders. An optometrist has a practice doctorate and focuses on vision. A clinical psychologist is a behavioral health expert. Reference: Chapter 8: Communication, p. 176.
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? A) analysis B) comfortable sense of self C) positive regard D) empathy
A) analysis Explanation: Empathy, positive regard, and a comfortable sense of self were among the key ingredients. Empathy is an objective understanding of the way in which a client sees his or her situation, identifying with the way another person feels, putting yourself in another person's circumstances, and imagining what it would be like to share that person's feelings. Communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions or regard with the client and family. Comfortable sense of self is part of the nursing confidence in caring for clients. Analysis is part of the nursing process and not the key elements of therapeutic communication. Reference: Chapter 8: Communication, p. 165.
The nurse communicates with a newly admitted client. Which nonverbal behavior will the nurse note? A) client's gestures B) client's accent C) client's religious practices D) client's ethnicity
A) client's gestures Explanation: Nonverbal communication refers to the use of body language, such as gestures, facial expressions, posture, space, appearance, body movement, and touch. The other answers refer to aspects of the client's cultural identity rather than nonverbal communication. Reference: Chapter 8: Communication, pp. 151-152.
A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should: A) involve the child's stuffed animal in the educational session. B) ask the child's parents to leave the room while the nurse and child talk. C) show the child the intravenous catheter and explain how it works. D) provide both verbal and written information to the child.
A) involve the child's stuffed animal in the educational session. Explanation: Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy. The use of music, art, and interior decorations might help put the client at ease. A client with newly diagnosed human immunodeficiency virus (HIV) infection will find it difficult to discuss sexual history or genital warts in an area that lacks privacy. A toddler might find it easier to communicate if a parent, favorite stuffed animal, or blanket is nearby. The parent should not be asked to leave the room and this may cause panic or anxiety in the child. A 3-year-old child will not be able to read written materials. Showing the child the catheter may frighten the child. Reference: Chapter 8: Communication, p. 158.
A 19-year-old male college student accompanies the pregnant partner to the emergency department. The client states, "My parents are not aware that I am having a child with my partner. If they do, they might not send me to school anymore. What is the best thing to do?" The nurse responds, "What do you think is the best thing to do?" The therapeutic communication technique employed by the nurse is Select... A) reflection B) restatement C) clarifying as evidenced by Select... D) directing the client's response back to the client E) attempting to obtain more information F) responding with a supportive question
A) reflection D) directing the client's response back to the client Explanation: Reflecting is a therapeutic communication strategy that suggests the nurse following through with the discussion. It is a technique that involves reflecting back the client's emotions or statements. The nurse may need to obtain more information to better assist the client's situation using the directing question technique; however, this technique would not be accomplished by the nurse's stated question in the scenario. Using the directing question technique, the nurse might ask, "What makes you think your parents will make you return home?" Responding with a supportive question acts to validate that the client's question was heard; however, the nurse's comment in the provided scenario does not provide support or validation. Using the supportive question technique, the nurse might ask, "Your parents do not know your girlfriend is pregnant and you are worried they will no longer allow you to attend school. Did I understand you correctly?" Reference: Chapter 8: Communication, Interviewing Techniques, pp. 170-171.
The client does not speak the dominant language. The nurse plans on providing preoperative teaching and uses an interpreter to communicate with the client. What intervention(s) will the nurse employ to aid in interpretation? Select all that apply. A)Inform the interpreter of the expected outcome of the communication exchange. B)Position the interpreter to sit between the nurse and the client. C)Look at the client while speaking. D)Allow the interpreter to elaborate extensively in the client's language. E)Speak slowly, using nontechnical terms.
A)Inform the interpreter of the expected outcome of the communication exchange. C)Look at the client while speaking. E)Speak slowly, using nontechnical terms. Explanation: When communicating with a client who has no or limited understanding of the dominant language, the nurse ensures the interpreter understands the purpose of the communication. This is to facilitate understanding with the interpreter regarding the conversation. The nurse will sit between the client and the interpreter, looking at the client through most of the exchange. These acts promote communication and demonstrate the importance of the client to the client. To ensure the content is communicated, the nurse instructs the interpreter to only interpret what is being said. The nurse takes time for the communication process, speaking slowly and using simple, nontechnical terms. Reference: Chapter 8: Communication, Language and Communication, pp. 85-86.
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: A)swaddling the child and gently stroking its head. B)softly humming a song near the neonate. C)staring into the neonate's eyes and smiling. D)offering the neonate infant formula
A)swaddling the child and gently stroking its head. Explanation: Touch is the most highly developed sense at birth. Tactile experiences of infants and young children appear essential for the normal development of self and awareness of others. It has also been found that many older people long for touch, especially when isolated from loved ones because of hospitalization or long-term care facility care. Vision, taste, and hearing are not as fully developed as touch in the neonate. Reference: Chapter 8: Communication, p. 169.
A nurse is calling a health care provider to communicate a change in the client's condition. According to the ISBARR format for handoff communication among health care personnel, which is the most appropriate way to begin the conversation? A) "Good morning, I am calling about Mrs. Jones, who is a client of yours." B) "My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital." C) "My name is Sue, and I am calling about Mrs. Jones, a client of yours at Jefferson Hospital." D) "I have a client of yours at Jefferson Hospital who is experiencing a change in condition and needs to be seen immediately!"
B) "My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital." Explanation: ISBARR was recently revised by the QSEN institute to include initial identification of the nurse and the client. The nurse should identify oneself and one's role during the initial conversation with the health care provider, as in the answer in which the nurse states the full name and degree. This allows the health care provider to understand the role of the nurse should the health care provider need to provide orders or instructions regarding the client. The other responses fail to identify the nurse in the beginning of the conversation or fail to adequately identify the client. Reference: Chapter 8: Communication, pp. 159-161.
A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client? A) "I will be by your side throughout the procedure; the procedure will be painless if you don't move." B) "The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." C) "The procedure may take only 2 minutes, so you might get through it by mentally counting up to 120." D) "You may feel very uncomfortable when the needle goes in, but you should breathe rhythmically."
B) "The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." Explanation: The nurse should provide correct knowledge as well as reassurance. Thoracentesis is a painful procedure and it is important for the client to sit still to avoid injuring the pleura. The nurse should reassure the client that the nurse will be present during the procedure and help the client throughout. Likewise, the nurse should avoid giving false reassurance by saying that the procedure will be painless. Additionally, the nurse should abstain from stating reasons that could scare the client. Reference: Chapter 8: Communication, p. 159.
Which is an open-ended question? A) "Do you take this medication daily?" B) "Why did the health care provider prescribe this medication for you?" C) "When was the last time you had your prescription refilled?" D) "How many tablets do you take at one time?"
B) "Why did the health care provider prescribe this medication for you?" Explanation: Open-ended questions (e.g., "Why was this medication prescribed for you?") give the client an opportunity to express what the client understands and prevent the client from answering with just "yes" or "no" or some other one-word response. The other three responses require only a one-word response (e.g., "yes" or "no") and so are closed-ended questions. Reference: Chapter 8: Communication, p. 170.
Which nurse would most likely be the best communicator? A) An advanced practice nurse B) A nurse who easily develops a rapport with clients C) A nurse who is bilingual D) A nurse who is proficient in sign language
B) A nurse who easily develops a rapport with clients Explanation: Rapport, a feeling of mutual trust experienced by people in a satisfactory relationship, facilitates open communication. Advanced practice does not make an individual an effective communicator. Although being bilingual or proficient in sign language allows a nurse to communicate with more people, it does not necessarily make the communication meaningful or effective. Reference: Chapter 8: Communication, p. 161.
A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point? A) Explaining in detail all of the pain management options available B) Being sensitive to the client's emotional barriers C) Sharing the nurse's own family and personal history of back pain D) Reassuring the client that back surgery will likely alleviate the pain completely
B) Being sensitive to the client's emotional barriers Explanation: The nurse should try to establish a good rapport with the client and use therapeutic communication. In doing so, the nurse should be sensitive to all needs of the client-including physical and emotional. The degree to which clients are physically comfortable influences their ability to communicate. Once rapport is established, the nurse and client can communicate about pain management options, although perhaps not in great detail, as the client may not be able to tolerate lengthy explanations. The nurse sharing the nurse's own family and personal history of back pain takes the focus off of the client and is not sensitive to the client's needs. Telling the client that back surgery will likely alleviate pain completely is providing false assurance, as this is not necessarily true. Reference: Chapter 8: Communication, p. 157.
During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking, "Have you been hospitalized this year for your back pain?" This is an example of which type of question? A) Open-ended question B) Closed question C) Sequencing question D) Reflective question
B) Closed question Explanation: An open-ended question is often used when the nurse is obtaining a nursing history and allows the client to reply with a wide range of possible responses, thus encouraging free verbalization. A closed question is answered by one or two words, often "yes" or "no." A sequencing question is used to place events in a chronological order and to investigate a possible cause-and-effect relationship. A reflective question involves repeating what the person has said or describing the person's feelings. Reference: Chapter 8: Communication, p. 170.
Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached? A) Sympathy B) Empathy C) Kindness D) Commiseration
B) Empathy Explanation: Empathy refers to intuitive awareness of what the client is experiencing. It helps the nurse perform activities and remain emotionally neutral. Sympathy means feeling as emotionally distraught as the client. If the nurse sympathizes with the client, the nurse may feel equally disturbed, and performance may be affected. Kindness and commiseration also have an emotional component attached to them. Reference: Chapter 8: Communication, p. 165.
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive? A) Posture B) Facial expressions C) Eye contact D) Hand gestures
B) Facial expressions Explanation: The face is the most expressive part of the body. Eye contact or the lack thereof, posture, hand gestures, and silence are other methods of nonverbal communication but do not provide as much information about what the person is communicating as do facial expressions. Reference: Chapter 8: Communication, p. 152.
When caring for a psychiatric client, a nurse would make a formal contract with the client during which phase of the nurse-client relationship? A) Intimate phase B) Orientation phase C) Working phase D) Termination phase
B) Orientation phase Explanation: In the psychiatric setting, the orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are used as a therapeutic tool to help a client develop more insight and control over behavior. The working phase consists of the nurse and client working together to achieve the client goals established in the orientation phase. The termination phase consists of evaluating the client's progress toward meeting the goals and concluding the relationship. There is no intimate phase in the nurse-client relationship. Reference: Chapter 8: Communication, p. 162.
The nurse makes a contract with the client during which phase of the nurse-client relationship? A) Intimate phase B) Orientation phase C) Working phase D) Termination phase
B) Orientation phase Explanation: The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase. Reference: Chapter 8: Communication, pp. 162-163.
A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation? A) The client is sitting in a chair and states, "I feel a lot better than I did yesterday. B) The client stares at the floor and states, "I feel fine." C) The client smiles at the nurse and states, "I cannot wait to go home." D) The client looks at the nurse and states, "I am still not feeling my best."
B) The client stares at the floor and states, "I feel fine." Explanation: It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, in the scenario in which the client stares at the floor while claiming to feel fine, the nurse should investigate further because of the incongruence between the client's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication is effective and no further investigation is warranted. Reference: Chapter 8: Communication, p. 156.
In the provision of care and the establishment of the therapeutic relationship, the nurse must first: A) understand the client's response. B) be aware of one's own personality. C) avoid labeling clients. D) treat the client with dignity.
B) be aware of one's own personality. Explanation: Before a nurse can communicate therapeutically, a comfortable sense of self, such as being aware of one's own personality, values, cultural background, and style of communication, is necessary. The other answers represent important aspects of the therapeutic relationship but would occur after the nurse becomes aware of one's own personality. Reference: Chapter 8: Communication, p. 164.
A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because the nurse has not often performed wound care on a complex wound. Using effective intrapersonal communication, this nurse should: A) inform the client that several nurses will be needed to care for this wound. B) tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. C) tell the unlicensed assistive personnel (UAP) to gather supplies and to prepare to cleanse and dress the wound. D) ask the charge nurse to change the assignment.
B) tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. Explanation: Intrapersonal communication, or self-talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the client and family. Understanding the importance of intrapersonal communication can also help the nurse work with clients and families whose negative self-talk affects their health and self-care abilities. Speaking directly to the client, a UAP, or charge nurse is interpersonal communication, not intrapersonal. This duty cannot be delegated to an UAP. The nurse should not ask the charge nurse to change the assignment but could ask for help in dealing with the complex wound. Reference: Chapter 8: Communication, p. 154.
The child of a client who just died in a hospice unit arrives and asks, "May I please stay and sit at the bedside? I really wanted to be here so my dad would not die alone." Which statement made by the nurse best demonstrates the use of empathy? A)"You are too late for that, but you may stay for a while if you would like." B)"I will close the door so you can spend some quiet time at the bedside." C)"I tried to contact you earlier, but you did not answer your phone." D)"I understand. I lost my dad last year, and he died alone."
B)"I will close the door so you can spend some quiet time at the bedside." Explanation: Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Empathy helps nurses become effective at providing for the client's needs while remaining compassionately detached. Sympathy, belittling, and defending are all nontherapeutic forms of communication. Reference: Chapter 8: Communication, p. 165.
A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established? A)Evaluation phase B)Orientation phase C)Working phase D)Termination phase
B)Orientation phase Explanation: During the orientation phase, the nurse discusses with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the nurse and client acknowledge that the agreement on which the relationship is based is concluding. There is no evaluation phase of the nurse-client relationship (evaluation is the final step in the nursing process). Reference: Chapter 8: Communication, p. 162.
Paramedics arrive in the emergency department with a client who was in a motor vehicle collision. The paramedic reports that the driver was restrained, the car was traveling about 30 miles per hour (48 km/hr), and the air bags were not deployed. The paramedic continues to report that the car was struck from behind and that all individuals in the car were able to self-extricate. Which statement made by the nurse is verifying the report from the paramedic? A) "Was there any cracking of the windshield?" B) "Were there any fatalities in the other vehicle?" C) "All of the people got themselves out of the car?" D) "Did a police officer take a report at the accident scene?"
C) "All of the people got themselves out of the car?" Explanation: A validation question or comment serves to validate what the nurse believes the nurse has heard or observed. Asking for additional information that was not reported is not validating the report given by the paramedic. Reference: Chapter 8: Communication, p. 170.
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic? A) "You should try laser surgery." B) "Why don't you try laser surgery?" C) "Have you ever thought of laser surgery?" D) "My grandfather also benefited from laser surgery."
C) "Have you ever thought of laser surgery?" Explanation: "Have you ever thought of laser surgery?" is a therapeutic response and encourages the client to express the client's own views. Statements such as, "You should try laser surgery"; "Why don't you try laser surgery"; and "My grandfather also benefited from laser surgery" are nontherapeutic and are equivalent to giving advice. Reference: Chapter 8: Communication, pp. 166-167.
A nurse is asking a colleague about a situation. Which response best demonstrates assertive communication? A) "Why are you treating me this way?" B) "You always act like this." C) "I think there is a better way to handle this." D) "What is your problem with me?"
C) "I think there is a better way to handle this." Explanation: Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a non-defensive manner. "I" statements—"I feel . . ." and "I think . . ."—play an important role in assertive statements. They communicate personal feelings and preferences without expressing a judgment or blaming another person. Reference: Chapter 8: Communication, p. 171.
A client with a cardiac arrythmia 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: A) "Do you check your blood pressure and pulse before you take your medication?" B) "Have you tried exercising at all in the last week or two?" C) "Were you tired and depressed before starting the new medication?" D) "Tell me about the foods you are eating."
C) "Were you tired and depressed before starting the new medication?" Explanation: Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence. The symptoms the client is complaining of are common adverse effects of this drug. Sequencing can determine the cause and effect in this scenario. Clients taking metoprolol should check their blood pressure and pulse before taking their medication. Asking about the current diet or exercise regimen does not uncover the cause and effect. Reference: Chapter 8: Communication, p. 170.
A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse? A) "Don't worry about labor, I have been through it and it is not so bad." B) "There are many good medications to decrease the pain; it will not be so bad." C) "You're worried about how you will tolerate the pain associated with labor." D) "I would recommend keeping a positive attitude."
C) "You're worried about how you will tolerate the pain associated with labor." Explanation: Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives. Reference: Chapter 8: Communication, p. 170.
The nurse is providing care to an older adult client who has visual and hearing deficits. What action by the nurse is appropriate to help with communication? A) Remove the COVID protection face mask while speaking with the client. B) Speak in a loud voice over the volume of the television set. C) Identify oneself by name and title with each entry into the client's room. D) Obtain the client's attention by calling out the client's first name.
C) Identify oneself by name and title with each entry into the client's room. Explanation: To facilitate communication with an older client who has visual and hearing deficits, the nurse identifies oneself by name and title each time the nurse enters the client's room. This assists with the orientation of the client who can place the interaction into proper perspective. The nurse does not remove one's face mask. The face mask is to minimize the risk for COVID for both the nurse and the client. The nurse with permission of the client would decrease the volume of the television set, or even turn the television set off, so as to not compete with the television program. This will facilitate hearing. People with hearing deficits have difficulty distinguishing simultaneous sounds from each other. The nurse will call the client by the client's preferred name. This demonstrates respect for the client. The client's name preference may not be the client's first name. Reference: Chapter 8: Communication, Box 8-6 Communicating with Patients Who Have Special Needs, p. 176.
A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment? A) Direct the client in the other bed to walk in the hallway. B) Ask all visitors to leave the room. C) Pull the curtain dividing the two beds. D) Bring the client into the hallway to discuss the treatment plan.
C) Pull the curtain dividing the two beds. Explanation: It might not always be possible to carry on conversations alone with the client in a room, but every effort should be made to provide privacy and to prevent conversations from being overheard by others. Sometimes merely drawing the curtains around the bed in a hospital or long-term care facility, or sitting in a corner of the waiting room or lounge, can provide the sense of privacy that is so important in most interactions. It is not appropriate to ask the client in the other bed or any visitors to leave the room. Personal information should not be discussed in public thoroughfares. Reference: Chapter 8: Communication, Privacy, Confidentiality, and Professionalism, p. 355.
The nurse meets with the client to teach self-administration of low molecular weight heparin. During the initial part of the training the client shakes the head and asks the nurse to repeat the instructions. What action demonstrates that the nurse has assessed the client's communication abilities? A) The nurse stops the instruction and tells the client that a call will be placed to the health care provider to get an order to have a home health nurse administer the medication. B) The nurse continues with the instructions and makes a mental note to repeat the initial instructions at the end of the training. C) The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe. D) The nurse asks the client if he or she is worried about giving oneself an injection.
C) The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe. Explanation: During the initial phase of the nurse-client relationship the nurse assesses the client's verbal and nonverbal communication. Shaking the head and requests to repeat what has been said points to a hearing deficiency. Facing the client, speaking slowly and clearly, and providing a visual demonstration is effective for communicating with individuals with a hearing impairment. Making a mental note to repeat instructions is a poor nursing action regardless of the communication difficulties of the client, because the nurses failed to let the client know the plan to repeat the instructions. Stopping the instruction and getting a home health nurse to administer the medication demonstrates that the nurse interpreted the client's communication as unwilling or as an inability to self-administer. This misinterpretation may result in an unnecessary healthcare expense. The nurse asking the client if he or she is worried demonstrates that the nurse is ignoring or not paying attention to the client's communication abilities. Reference: Chapter 8: Communication, Patient Variables That Can Negatively Influence an Interview and Suggested Nursing Responses, p. 352.
When communicating with a client, the nurse uses reflection for which purpose? A) To determine the sequence of events in the conversation B) To keep the client on the topic of concern C) To have the client elaborate on thoughts and feelings D) To investigate the situation to help problem solve
C) To have the client elaborate on thoughts and feelings Explanation: The reflective question technique involves repeating what the person has said or describing the person's feelings. It encourages clients to elaborate on their thoughts and feelings. Exploring helps clients express their concerns and solve their problems by investigating the situation, exploring how they feel about it, and what some alternatives might be. Focusing helps the client stay on the topic. Sequencing determines events in chronological order. Reference: Chapter 8: Communication, p. 177.
Which nursing actions help improve listening skills when conversing with clients? Select all that apply. A) Sitting with the arms crossed B) Always maintaining eye contact with the client in a face-to-face pose C) Using facial expressions and body gestures to indicate attention to what the client is saying D) Thinking before responding to the client, even if this creates a lull in the conversation E) Listening for themes in the client's comments F)Pretending to listen to the client while performing a task rather than interrupting the client's conversation
C) Using facial expressions and body gestures to indicate attention to what the client is saying D) Thinking before responding to the client, even if this creates a lull in the conversation E) Listening for themes in the client's comments Explanation: The following nursing actions would help improve listening skills when conversing with clients: using facial expressions and body gestures to indicate attention to what the client is saying; thinking before responding to the client, even if this creates a lull in the conversation; and listening for themes in the client's comments. The nurse should not cross the arms or legs while communicating with a client because this body language conveys a message of being closed to the client's comments. A face-to-face pose and maintaining eye contact would not be appropriate in all nurse-client relationships. The nurse would not pretend to listen to the client while performing a task rather than interrupting the client's conversation. Reference: Chapter 8: Communication, p. 168.
A nurse touches the client's hand while discussing the client's diagnosis. This action is: A) a dynamic process. B) a translation. C) a communication channel. D) an auditory channel.
C) a communication channel. Explanation: A communication channel is a carrier of the message; touch can be a channel. Communication is a dynamic process, but simply touching one's hand is not. Touch is not translation--converting a message from one form to another--but is a channel for the message. Touch is a tactile, not auditory, channel. Reference: Chapter 8: Communication, p. 150.
A nurse is caring for an older adult client hospitalized following a hip fracture. Which action(s) by the nurse will promote the development of a therapeutic relationship? Select all that apply. A) talking with another nurse during a bedside change of shift report B) addressing the client by the client's first name C) asking the client when the client would like to have the bed linens changed D) encouraging the client to talk about the client's life E) assisting the client with the completion of all activities of daily living
C) asking the client when the client would like to have the bed linens changed D) encouraging the client to talk about the client's life Explanation: The nurse can promote the development of a therapeutic relationship by asking the client about personal preferences, such as when the bed linens should be changed, as well as encouraging the client to share personal stories. Both of these actions will help provide the nurse with specific information about the client which will enable a better therapeutic relationship. The other choices do not support or promote the development of a therapeutic relationship because they are not focused on the client. Reference: Chapter 8: Communication, p. 164.
A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to: A) plan a meeting where the dominant person cannot attend. B) pick a team leader who is not the dominant member. C) have group members confront the dominant member to promote the needed team work. D) have group members issue a written warning to the dominant member.
C) have group members confront the dominant member to promote the needed team work. Explanation: Effective groups have members who are mutually respectful. If a group member dominates or thwarts the group process, then the leader or other group members must confront the member to promote the needed collegial relationship. Planning a secret meeting does not solve the underlying issue. Picking a team leader who is not the dominant member will not address the dominance issue. A written warning would be inappropriate; a verbal communication is what is required among the team. Reference: Chapter 8: Communication, p. 155.
To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others? A)Metacommunication B)Purposive communication C)Therapeutic communication D)Intrapersonal communication
C)Therapeutic communication Explanation: Therapeutic communication facilitates interactions focused on the client and the client's concerns. Therapeutic communication is purposive, but this is not a discrete category of communication. Intrapersonal communication is communication with oneself, or self-talk. Metacommunication is communication about communication. Reference: Chapter 8: Communication, p. 167.
A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication? A) "Close your eyes and take a deep breath. I know you were frightened, but the infant is healthy and everything is going to be okay." B) "This is great news. You don't have anything to worry about and the infant is doing well." C) "I can help you, please talk to me so that I know how I can help you." D) "Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you."
D) "Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you." Explanation: Nurses often rely on verbal and nonverbal cues from clients to verify whether client objectives or goals have been achieved. It is therapeutic to allow for a pause in the communication by giving the client time to think about the situation and what has happened. Rescuing, false reassurance, and moralistic judgement are not therapeutic and could lead to client disappointment, minimizing the client's concerns, or inference on what is the "right" way to feel. Reference: Chapter 8: Communication, p. 148.
When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is: A) "It sounds as if your surgery is a pretty scary procedure." B) "You have a great surgeon. You have nothing to worry about." C) "You shouldn't be nervous. We perform this procedure every day." D) "The thought of having surgery is keeping you awake."
D) "The thought of having surgery is keeping you awake." Explanation: Reflection means repeating or paraphrasing the client's own statement back to the client to verify that the nurse understands what the client is saying. identifying the main emotional themes. Saying that the surgery sounds scary does not accurately reflect this client's statement. The other answers are offering false reassurance, which is not reflection nor therapeutic communication. Reference: Chapter 8: Communication, p. 177.
The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique? A) Restating B) Clarification C) Reflection D) Encouraging elaboration
D) Encouraging elaboration Explanation: Encouraging elaboration involves making simple statements that indicate active listening and comprehension on the part of the nurse and that prompt the client to continue talking. This technique helps the client to describe more fully the concerns or problems under discussion. Clarification involves asking a follow-up question about a statement made by the client to clear up some point that the nurse is not sure about or to elicit more specific details. Reflection and restatement involve the nurse repeating back to the client a comment made by the client to ensure that the nurse has correctly heard or understood the client. Reference: Chapter 8: Communication, pp. 166-167.
The nurse is providing education to a client who sometimes has difficulty remembering information. Which form of communication will be most helpful for this client? A) Verbal communication B) Metacommunication C) Nonverbal communication D) Written communication
D) Written communication Explanation: While all forms of communication can be used during education, it will be essential to use written communication for this client. This will allow the client to refer back to important points presented. Reference: Chapter 8: Communication, pp. 158-159.
A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be: A) passive. B) nurturing. C) assertive. D) aggressive.
D) aggressive. Explanation: Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. Reference: Chapter 8: Communication, p. 171.
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: A) ask questions as quickly as possible. B) use only open-ended questions. C)tell the client to rest and allow a family member to answer. D) allow the client to set the pace.
D) allow the client to set the pace. Explanation: It would be ineffective to rush through a list of questions when obtaining a nursing history; it is more effective to let the client set the pace. Let the client know at the beginning of the interaction if time is limited so that the client does not feel that you are rushing because of a lack of concern or personal interest. Open-ended questions do not apply to "yes or no" answers. The client should be the person answering the questions unless unable to. Reference: Chapter 8: Communication, p. 166.
A nurse is caring for a client admitted to the hospital for dehydration. Which physical findings should the nurse acknowledge as nonverbal communication concerning this diagnosis? A) pallor and diaphoresis. B) slow heart rate and prolonged capillary refill. C) cold intolerance and brittle nails. D) easy wrinkling of the skin and sunken eyes.
D) easy wrinkling of the skin and sunken eyes. Explanation: Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone. On the other hand, a person in good health tends to radiate this healthy status through general appearance. Although prolonged capillary refill is consistent with dehydration, slow heart rate is not. Pallor may be associated with dehydration but diaphoresis is not associated with this condition. Cold intolerance and brittle nails are consistent physiologic changes seen in clients with hypothyroidism. Reference: Chapter 8: Communication, p. 153.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: A) ask the client's partner to leave the room to allow the client to focus. B) ask all visitors to leave the room. C) ask the client if she is able to read. D) eliminate as many distractions as possible.
D) eliminate as many distractions as possible. Factors that distort the quality of a message can interfere with communication at any point in the process. These distractors might be from the television, or from pain or discomfort experienced by the client. Visitors may remain in the room as long as the mother agrees and they do not interfere with the education session. It may also be beneficial for others to learn the care in the event that they too will be caregivers for the infant. For this reason, it is best for the client's partner to remain in the room. Reference: Chapter 8: Communication, p. 158.F
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should: A) ask the client for a urine specimen for urine drug use screening. B) consult with the social worker regarding inpatient drug rehabilitation. C) ask if the client realizes the infection is a direct result of the drug use. D) remain honest, open, and frank.
D) remain honest, open, and frank. Explanation: One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice. When a client feels that a nurse is being judgmental, the client might withhold significant information. The nurse needs to develop sensitivity to the unique challenges presented by each client. A urine drug screen may eventually be ordered but is not necessary at this time. There is no evidence the client wants drug rehabilitation at this time. There is no evidence that the skin infection is secondary to the drug use. Reference: Chapter 8: Communication, p. 165.
A nurse is interviewing a client for the establishment of long-term care insurance. During the interview, the nurse asks questions regarding the client's past medical history. In this case, the nurse plays the role in the process of communication of the: A) decoder. B) target. C) receiver. D) sender.
D) sender. Explanation: The nurse is playing the role of the sender, which is a person or group who has a purpose for the communication and initiates and conveys the message. The receiver, or decoder, is the person or group who receive and interpret, or decode, the message. Target is not a term used to describe a role in the communication process. Reference: Chapter 8: Communication, p. 150.
A client has cancer, but the significant other does not want the client to know the diagnosis. The nurse demonstrates sensitivity to the significant other and works with the couple to achieve desired outcomes. What kind of behavior is the nurse exhibiting? A)Humility B)Sympathy C)Curiosity D)Empathy
D)Empathy Explanation: An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. Sympathy is the expression of sorrow for someone's situation, involving compassion and kindness. Sympathy shifts the emphasis from the client to the nurse, as the nurse shares feelings and personal concerns and projects them onto the client. Curiosity is a strong desire to know or learn something. Empathy is perceptive awareness of what a client is experiencing. Humility is a modest or low view of one's own importance. Reference: Chapter 8: Communication, p. 165.
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply. If there is no response, the nurse does not repeat what is said and takes a break. A) The nurse gives lengthy explanations of the care that will be given. B) The nurse communicates in a busy environment to hold the client's attention. C) The nurse keeps communication simple and concrete. D) The nurse shows patience with the client and gives the client time to respond. E) The nurse maintains eye contact with the client.
E) The nurse maintains eye contact with the client. D) The nurse shows patience with the client and gives the client time to respond. C) The nurse keeps communication simple and concrete. Explanation: There are several nursing actions that would be appropriate to facilitate. The nurse would maintain eye contact with the client. The nurse shows patience and gives the client time to respond. The nurse keeps communication simple and concrete. The nurse would not communicate in a busy environment because this could be distracting to the client. The nurse would not give lengthy explanations to the client regarding the care to be given. The nurse would repeat the information if no response was shared by the client. Reference: Chapter 8: Communication, p. 177.
Which activities take place during the working phase of the nurse-client relationship? Select all that apply. A)The client genuinely expresses concerns to the nurse. B)The client describes the role that the nurse plays in the relationship. C)The client identifies the goals accomplished in the relationship. D)The client and nurse identify goals of the relationship. E)The client participates actively in the relationship.
E)The client participates actively in the relationship. A)The client genuinely expresses concerns to the nurse. Explanation: The working phase of the nurse-client relationship involves the client actively participating in working toward goals and genuinely expressing concerns and feelings to the nurse. The identification of goals and roles of the relationship occurs in the orientation phase. Identifying that goals have been accomplished is characteristic of the termination phase. Reference: Chapter 8: Communication, pp. 162-163.
The nurse is caring for a 25-year-old client admitted to a medcial surgical unit after an emergency appendectomy. The newly admitted client has been assigned under the nurse's care. As part of the care plan, the nurse sets specific client goals. The client states, "Using the pillow to splint my abdomen when I cough, really helps." The client states, "I know I have to get up and moving so I do not get pneumonia." The client is able to call the nurse by name and demonstrate how to use the call light. The client verbalizes understanding of what signs indicate infection and when to contact the health care provider.
Working Phase Working Phase Orientation Phase Termination Phase Explanation: The orientation phase is the initial phase of the nurse-client relationship. During this phase, specific client and nurse roles are discussed, including the duration of the therapeutic relationship. The nurse also orients the client to the room and environment as well as identify oneself by name. After the initial orientation, the client should be able to verbalize understanding of the room including being able to demonstrate how to use the call light and identify the nurse by name. The second phase of the nurse-client relationship is the working phase. Participation and cooperation between the nurse and the client are the highlights of this phase. In addiiton, verbalization of concerns and feelings also occur in the working phase. The nurse takes on the role of teacher during this phase by instructing and motivating the client to implement health-promoting activities meant to facilitate the client's ability to execute the nursing plan. The client 's statements, "I know I have to get up and moving so I do not get pneumonia," and "Using the pillow to splint my abdomen when I cough, really helps" indicates understanding of the nurse's teachings. The last phase of the nurse-client relationship is the termination phase. Evaluation of goals and termination of the therapeutic relationship occur during this phase. This can occur at the end of the nurse's shift or when the client is discharged. The client's ability to verbalize understanding of what signs indicate infection and when to contact their health care provider, allows the nurse to evaluate the client's goal progression as well as assess their readiness for discharge. Reference: Chapter 8: Communication, Box 8-3 Summary of Patient Goals for the Three Phases of the Helping Relationship, p. 163.
