Collaborative Practice and Care Coordination Across Settings
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?
"All of the people got themselves out of the car?"
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?
"Have you ever thought of laser surgery?"
The nurse is performing an admission interview with a new client diagnosed with acute coronary syndrome. For the nurse to obtain information and allow the client free verbalization, which question would elicit the most information?
"Could you tell me more about how you are feeling right now?"
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?
"I know this is hard for you. Is there any way I can help?"
A client was recently diagnosed with metastatic lung cancer. The nurse finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy?
"I see you are upset. Would you like to talk?"
The nurse is talking with a client who is thinking about obtaining a second opinion regarding the surgeon's recommendation for surgery. Which response by the nurse is considered an advocacy response?
"Let us know if we can answer any further questions after you obtain your second opinion."
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?
"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."
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask:
"Were you tired and depressed before starting the new medication?"
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?
"What is your name?"
A nurse is conducting a health history. The client's spouse is answering the interview questions. What question would be appropriate to ask the client before proceeding with the remainder of the interview?
"Who manages health care-related issues in your family?"
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?
"You're worried about how you will tolerate the pain associated with labor."
In which situation would the SBAR technique of communication be most appropriate?
A nurse is calling a physician to report a client's new onset of chest pain.
Which nurse would most likely be the best communicator?
A nurse who easily develops a rapport with clients
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?
Assess how the client would like to communicate
A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response?
Be silent and allow the client to continue speaking when ready.
A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take?
Contact a professional interpreter.
Which is a skill appropriate to use in therapeutic communication?
Control the tone of the voice to avoid hidden messages.
A client, who was recently diagnosed with diabetes, has been coming to the emergency room every day for hyperglycemia. The client reports not being able to self-administer insulin injections. What strategy would best educate the client and improve the client's ability to self-administer insulin?
Demonstrate the proper method and have the client mimic the demonstration.
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?
Empathy
Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached?
Empathy
The nurse is visiting a hospice client in 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?
Encouraging elaboration
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive?
Facial expressions
A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique?
Giving false reassurance
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?
The client stares at the floor and states, "I feel fine."
Several nurses on the same hospital unit communicate on the same social networking site. A nurse posts the following statement to the social networking page, "The lady in room 34 with heart failure was a train wreck!" In which manner has the nurse failed to apply the principles of confidentiality?
Sharing information about a client beyond the area of client care is unacceptable and breaches the client's confidentiality rights.
The nurse is caring for a client. When does the nurse determine that nursing care will be most effective related to nurse-client communication?
common understanding
A registered nurse (RN) working with an experienced licensed practical/vocational nurse (LPN/LVN) delegates the task of administering oral medications to a group of clients. The LPN/LVN documents a client's medication administration before entering the client's room. What action will the LPN/LVN anticipate?
The RN will stop the LPN/LVN immediately and discuss the possible consequences of this action.
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?
The nurse gently strokes the baby's cheek to facilitate breastfeeding.
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.
The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond. The nurse keeps communication simple and concrete.
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?
The working phase
When communicating with a client, the nurse uses reflection for which purpose?
To have the client elaborate on thoughts and feelings
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:
aggressive.
A nurse communicating with a client states, "I will be changing your dressing, but we have plenty of time to talk first." She is already wearing sterile gloves and a mask and is busy working with her back to the client. The nurse is conveying:
an incongruent relationship.
A nurse anticipates collaborating with the nurse aide, physical therapist, surgeon, and respiratory therapist in which circumstance?
caring for a client following a total hip replacement
Each of the following facilitates a therapeutic nurse-client relationship except:
closed-ended questions.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:
eliminate as many distractions as possible.
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:
have group members confront the dominant member to promote the needed team work.
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.
A nurse gives a speech on nutrition to a group of pregnant women. Within the model of the communication process, what is the speech itself known as?
message
A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse:
sits at the client's bedside and faces the client.
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.
A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse: il discharge represents which phase of the nurse-client relationship?
Working phase
Mrs. Miller is a 60-year-old woman status post a hip replacement. She has had multiple complications following surgery including a skin infection and a blood clot. As a result, she has been a client on the unit for 6 weeks. The nurse has just returned from vacation and this is her first day caring for Mrs. Miller. A colleagues looks at the nurse and describes Mrs. Miller as "quite difficult to deal with." The nurse knows that all of the following can contribute to difficult behaviors except:
a quiet room.
A nurse needs to complete an assessment and vital signs on a client who has Alzheimer disease. How should the nurse approach this client to gain cooperation? Select all that apply.
Approach the client from the front. Use the client's name. Smile and maintain eye contact.
