CHAPTER 8: COMMUNICATION (SAMPLE TEST)

A client who underwent a hysterectomy 4 days ago says to the nurse, "I wonder if I'll still feel like a woman." Which response would most likely encourage the client to expand on this and express concerns in more specific terms?

"Feel like a woman . . ." Explanation: The best response of the options listed is the statement "Feel like a woman..." This response is a reflective comment, which allows the client to reflect and elaborate on feelings. Remaining silent is a skill that is appropriate many times, but not the most appropriate in the situation at hand. Asking a yes/no question such as "Do you want more children?" or "Do you feel like you are not a woman?" does not encourage the client to reflect and elaborate on feelings. Reference: Chapter 8: Communication - Page 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 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. Chapter 8: Communication - Page 170

A client reports to the primary health care facility reporting 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."

A Explanation: 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.

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. A. The nurse shows patience with the client and gives the client time to respond. B. The nurse communicates in a busy environment to hold the client's attention. C. The nurse maintains eye contact with the client. D. The nurse keeps communication simple and concrete. E. The nurse gives lengthy explanations of the care that will be given. F. If there is no response, the nurse does not repeat what is said and takes a break.

A, C, D 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.

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 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. Chapter 8: Communication - Page 152

A nurse who is caring for newborn infants delivers care by utilizing the sense that is most highly developed at birth. Which example of nursing care achieves this goal? A. The nurse gently strokes the baby's cheek to facilitate breastfeeding. B. The nurse speaks to the infant in a loud voice to get attention. C. The nurse wears colorful clothing to stimulate the infant. D. The nurse plays "peek-a-boo" with the infant.

B Explanation: The sense most highly developed at birth would be the sense of neurological reflex. The nurse gently stroking the baby's cheek to have the baby turn toward the stroke is a developmental reflex. The nurse would not use a loud voice or wear colorful clothing while caring for a newborn. The infant is not at the stage of development where playing "peek-a-boo" would be appropriate

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. Working phase B. Orientation phase C. Termination phase D. Intimate phase

B 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.

A nurse is calling a physician 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. "My name is Sue, and I am calling about Mrs. Jones, a client of yours at Jefferson Hospital." B. "Good morning, I am calling about Mrs. Jones, who is a client of yours." C. "My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 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!"

C 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 physician, as in the answer in which the nurse states the full name and degree. This allows the physician to understand the role of the nurse should the physician 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.

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 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.

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. Contact a person skilled in sign language B. Use facial and hand gestures C. Assess how the client would like to communicate D. Provide paper and pencil for written communication

C 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. Chapter 8: Communication - Page 176

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 performed wound care on a complex wound in the past. Using effective intrapersonal communication, this nurse should: A. tell the unlicensed assistive personnel (UAP) to gather supplies and to prepare to cleanse and dress the wound. B. ask the charge nurse to change the assignment. C. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. D. inform the client that several nurses will be needed to care for this wound.

C 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.

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? A. Pity B. Indifference C. Empathy D. Sympathy

C Explanation: The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.

A nurse visits a female victim of sexual assault. During the 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. "In reality, the sexual assault did not occur yesterday; it has been over one month now." B. "We should move on from the strong feelings associated with this incident." C. "Tell me more about the aspects that make you feel as if it happened yesterday." D. "Can you do something to alleviate the fear of being assaulted again?"

C Explanation: 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. This type of therapeutic approach happens during the working phase. The nurse should avoid giving an opinion and should in fact allow the client to hold on to the feelings. Making the client realize that the rape occurred a month ago would block communication.

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 bestdescribed in this scenario? A. The orientation phase B. The introduction phase C. The working phase D. The termination phase

C 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.

An experienced nurse is orienting a new nurse to the unit. Which activity demonstrates the nurse is an effective caregiver? A. The nurse documents the client was crying at the end of the shift. B. The nurse calls the hospital chaplain to talk with the client. C. The nurse leaves the room when a client is crying to provide privacy. D. The nurse uses open-ended questions when working with a crying client.

D Explanation: Any nurse who wishes to be an effective caregiver must first learn how to be an effective communicator. Good communication skills enable nurses to get to know their clients and, ultimately, to diagnose and to meet their needs for nursing care. By asking open-ended questions the nurse can gain more information as to why the client is crying. Without understanding the "why" behind the crying the nurse cannot determine if the hospital chaplain might be needed. Providing privacy for the client can be thoughtful but not a way to learn more.

A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask: A. "Tell me about the foods you are eating." B. "Do you check your blood pressure and pulse before you take your medication?" C. "Have you tried exercising at all in the last week or two?" D. "Were you tired and depressed before starting the new medication?"

D 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.

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. target. B. receiver. C. decoder. D. sender.

D 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.

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?

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.

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

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. Chapter 8: Communication - Page 158

A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:

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.