Communication and Interpersonal Relationship Practice Questions

Which question by an RN will best assess the quality of a patient's pain? 1. "Can you describe how your pain feels?" 2. "How do you manage your pain?" 3. "Can you rate your pain on a scale of 0 to 10?" 4. "What seems to increase your pain?"

1. "Can you describe how your pain feels?" *1) The quality refers to descriptors, such as sharp and burning, which are useful in identifying the cause of the pain. Only the patient can describe how the pain feels. 2) Management of pain provides information about relieving factors, not quality. 3) Rating the pain provides information about the intensity of pain, not quality. 4) Factors that increase pain are aggravating factors and do not address the quality.

An adolescent patient is feeling anxious before an impending eye surgery and asks the RN "Will I have to wear an eye patch for a long time?" What is the priority plan of care for this patient? 1. Exploring patient's concerns about perceived change in body image 2. Preoperative teaching for postoperative deep breathing techniques 3. Administering an anti-anxiety medication before the procedure 4. Explaining the surgical procedure and the risks involved

1. Exploring patient's concerns about perceived change in body image *1) Body image disturbance is a primary concern for adolescents. 2) The priority is addressing the patient's concern before attempting to teach the patient. 3) Anti-anxiety medication will not address the patient's concern regarding body image. 4) The surgeon obtains the operative consent by explaining the procedure and risks.

An RN is planning care for the family of a patient who has a traumatic brain injury. Which approach by the RN will best ensure that education for the patient and family will be successfully received? 1. Information will be provided initially with daily follow-up. 2. Questions will be answered immediately as the family and patient ask them. 3. Written and verbal information will be provided when the patient is stable. 4. Written materials will be provided at discharge.

1. Information will be provided initially with daily follow-up. *1) Information might include written, verbal, or video materials. The patient and family should be assessed at least daily for understanding and further educational needs. 2) This is not a plan and furthermore, it dangerously anticipates that the family and patient have enough knowledge to ask all the needed questions. 3) The family may have many questions before the patient is stable. It is better to be proactive about providing information. 4) Education must be provided in a way that is not overwhelming and that allows the patient and their family time to absorb, understand, and redirect with further questions.

The parent of a 15-year-old adolescent is distraught over the child's relapse of acute myeloid leukemia that had been in remission. Which response is most likely being exhibited by the parent? 1. Loss and grief 2. Denial and acceptance 3. Anger and acceptance 4. Denial and grief

1. Loss and grief *1) The families of people with physical health problems tend to respond to health conditions with feelings of loss and grief. 2) A person cannot have denial and acceptance at the same time. 3) A person cannot have anger and acceptance at the same time. 4) A person cannot grieve if they are in denial.

A patient is admitted to the hospital with abdominal pain. The patient, who is Christian, tells the RN that the pain is "a punishment from God." Which response is most appropriate for the RN in this situation? 1. "The pain is caused by the inflammatory process." 2. "You feel that God is punishing you by causing the pain." 3. "What do you feel you did wrong to deserve this?" 4. "I will call the hospital chaplain so you can talk about this."

2. "You feel that God is punishing you by causing the pain." 1) This statement does not address the patient's statement and actually contradicts it. *2) "Regardless of the view held and whether the RN agrees with the patient's beliefs in this regard, it is important to be aware of how the person views illness and health to work with this framework to promote patient care and wellness." Paraphrasing is a non-directive technique that encourages the patient to expand on a thought or feeling. This will enable the RN to be more aware of the patient's view. 3) The issue is not what the patient did wrong, but what beliefs the patient holds about pain. As posed, this is probing. The use of non-directive techniques gives the patient the opportunity to share such information, if desired. 4) The RN is responsible for completing the patient assessment. This is an example of passing the responsibility to another team member.

What are the characteristics of SMART goals? Select all that apply. 1. Simple 2. Achievable 3. Manageable 4. Tangible 5. Reasonable

2. Achievable 3. Manageable 5. Reasonable SMART goals are specific, measurable, reasonable, and time based.

The nurse demonstrates an understanding of patient-centered care when: 1. being careful to use costly dressing supplies appropriately but with their cost in mind. 2. discussing the client's wish to include herbal preparations to treat an illness. 3. promptly medicating clients when they request their PRN analgesic. 4. referring to evidence-based practice when planning client care.

2. discussing the client's wish to include herbal preparations to treat an illness. Patient-centered care involves providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Efficient care includes avoiding waste, effective care is based on scientific knowledge, and timely care focuses on reducing waits and delays in care delivery.

You are the night shift nurse and are caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the first nursing action to take? 1. Give the family the record 2. Give the patient the record 3. Discuss the issues that concern the family with them 4. Call nursing supervisor

3. Discuss the issues that concern the family with them

Which of the following is an example of a closed-ended question or statement? A. "Did you take those drugs?" B. "How did that medication make you feel?" C. "Tell me about things that relieve your pain?" D. "Describe the type of pain you have."

A. "Did you take those drugs?"

The client is newly diagnosed as having a terminal disease and asks, "I'm going to die soon, aren't I?" What would be appropriate replies of the nurse? [Select all that apply.] A. "Tell me how you feel." B. "No, you are not actively dying." C. "This is something I am not comfortable discussing." D. "What have you been told by your health care provider?" E. "You should ask your health care provider that question."

A. "Tell me how you feel." D. "What have you been told by your health care provider?"

The clinic nurse sees the client today and asks about his chief complaint. The client describes to the nurse his inability to be intimate with his wife. Which of the following would be a priority for the nurse to assess? [Choose all that apply.] A. Sleep quality B. Medication prescribed C. Level of stress at work D. Social activity E. Specifics about sexual problem

A. Sleep quality B. Medication prescribed C. Level of stress at work E. Specifics about sexual problem

The healthiest form of communication is the _______ style.

Assertive Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing.

The nurse is confused during the health interview of a 45 year old woman who keeps her arms crossed. The nurse's best course of action would be to: A) start the interview over because the nurse has probably offended the patient. B) ask the patient if anything is making her uncomfortable. C) be firm with the patient and let her know that this will be easier if she just relaxes. D) ignore the non-verbal communication and continue with the interview.

B) ask the patient if anything is making her uncomfortable. If this was enough to notice, ask an open ended question to see if this just might be normal behavior for the patient. A wastes time without confronting a potential problem, C assumes too much and may offend, D also ignores confronting a potential problem.

A student nurse is assigned to care for a preschool child who is scheduled for surgery. How can the student decrease the child's fears about the surgery? A. Explain that nothing is going to hurt and that it will soon be over. B. Be honest about the pain and use words the child can understand. C. Ask the child's parents to pretend that nothing is going to be done. D. Ignore the child's fears and focus on teaching the parents.

B. Be honest about the pain and use words the child can understand.

A nurse who provides care in a long-term care facility recognizes the need to promote health rather than solely treating illness. Which of the following measures should the nurse encourage among the older adult resident population of the facility? [Select all that apply.] A. Encourage frequent naps in order to ensure adequate sleep and rest. B. Encourage residents to consume diet and energy supplements. C. Conduct activities at a slower pace and allow residents time to respond. D. Encourage residents to engage in the present rather than perform reminiscence. E. Promote self-care and only assist residents when it is necessary.

C. Conduct activities at a slower pace and allow residents time to respond. E. Promote self-care and only assist residents when it is necessary.

Using Erikson's theory, which of the following activities would the nurse use to provide a sense of fulfillment and purpose in later adulthood? A. making a commitment to others B. trying on new and different roles C. reminiscing about life events D. becoming involved within the community

C. reminiscing about life events

In general, how do most people view change? A. By how it affects the cohesiveness of the group B. By how much it will cost in time and resources C. By how it will affect others on the staff D. By how they are affected personally

D. By how they are affected personally

A nurse is caring for an adolescent who is in the hospital for a long-term illness. Which of the following interventions would promote the development of the hospitalized adolescent? A. Provide the teen structure in daily activities. B. Encourage the family to have fun game night activities once a week. C. Arrange for a tutor to cover missed schoolwork. D. Connect the teen to their peer group as much as possible.

D. Connect the teen to their peer group as much as possible.

A patient tells the RN, "I don't think I'm ever going to get well." Which response by the RN would be most therapeutic? 1. "Why do you think you aren't going to get well?" 2. "It sounds as if you're feeling hopeless." 3. "Don't worry, you'll get better soon." 4. "Have you talked to your doctor about this?"

2. "It sounds as if you're feeling hopeless." 1) A question that begins with "why" asks the patient to justify their behavior and is not therapeutic. *2) In this response, the RN reflects back the patient's feelings and helps the patient explore the feelings. Reflection is a therapeutic technique. 3) In this response, the RN provides false reassurance to the patient and does not help the patient express feelings. 4) This response will not help the patient focus on feelings.

A pediatric patient is dying of cancer, after all treatment options have failed. The RN overhears patient's family members conversing in the pediatrics unit. Which of these statements between family members are representative of expected stages in the grieving process?(Select all that apply.) 1. "I don't understand how this could be happening, and it's not fair!" 2. "I'll do anything to make our child better." 3. "I can't stop crying. I can't eat or sleep." 4. "It's your fault that our child is dying." 5. "I'm going to get a third opinion on other treatment options."

1. "I don't understand how this could be happening, and it's not fair!" 2. "I'll do anything to make our child better." 3. "I can't stop crying. I can't eat or sleep." 5. "I'm going to get a third opinion on other treatment options." *1) This is the anger stage, in which one believes the diagnosis is unfair. *2) This is the bargaining stage, in which one attempts to correct the problem by making a bargain. *3) This is the depression stage, which often involves frequent crying and overall sadness. 4) This is blame; it is not one of the expected stages in the grieving process. *5) This is the denial stage, in which one denies the seriousness of the situation and continually seeks other options.

A widely used approach of encouraging cooperation between the health care professions is the use of: 1. Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS). 2. SBAR (Situation; Background; Assessment; Recommendation). 3. the Robert Wood Johnson Pilot School Collaboration. 4. Quality and Safety Education for Nurses (QSEN).

1. Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS). A widely used team training approach for health care teams is Team STEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). Team STEPPS acknowledges that team training and enhanced communication are among the essential components of a comprehensive patient safety system. The SBAR technique provides a succinct, structured framework for communication among members of the health care team about a patient's condition. QSEN is a national program with the goal of preparing future nurses with the knowledge, skills, and attitudes (KSA) necessary to continually improve the quality and safety of the health care systems in which they work. The Robert Wood Johnson Foundation supported the Pilot School Collaborative to model how faculty could include the six competencies in prelicensure programs.

Ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following? 1 Patients 2 Relationships 3 Ethical principles 4 Code of ethics for nurses

2 Relationships

A middle aged, obese woman repeatedly returns to her healthcare provider complaining of ankle pain but does not attempt to lose weight. The best response by the nurse when clarifying the client's values would be: a) "Have you thought about losing weight as that will help alleviate the pain?" b) "Let's look over the various actions that could possibly help alleviate the pain." c) "We have a great program for losing weight. Would you like more information? d) "It is important to follow the plan of care. Are you following the doctor's orders?"

b) "Let's look over the various actions that could possibly help alleviate the pain." Listing alternatives may help a client become aware of all actions available if the client appears to hold unclear or conflicting values related to a particular health problem. The nurse assists client to think through each question but does not impose personal values. Behavior that may indicate unclear value: Numerous admissions to a health agency for the same problem.

The nurse is caring for client 82 years of age who is struggling to adapt to hearing loss as he ages. The nurse performs which of the following interventions to assist the client in adapting to this sensory deficit? [Select all that apply.] A. Make sure he wears his hearing aid. B. Speak in a lower tone of voice. C. Speak so he can observe your lip motions. D. Keep his environment clear of clutter. E. Orient to person, place, and time frequently.

A. Make sure he wears his hearing aid. B. Speak in a lower tone of voice. C. Speak so he can observe your lip motions.

A patient who is terminally ill says the diagnosis is "unfair" and "wrong," is short-tempered with family, and responds only minimally and tersely with the RN. The RN identifies that, according to Kübler-Ross, this patient is in which stage of grief? 1. Anger 2. Bargaining 3. Denial 4. Depression

1. Anger *1) Anger is a response to a situation which is perceived as unjust or unfair. 2) The bargaining phase is characterized by attempts to negotiate alternative illness experiences or outcomes. 3) Denial is a phase of nonacceptance which allows the patient time to approach understanding and acknowledging the outcome. 4) Depression is a response to actual and anticipated loss. Depression is characterized by physical indicators or verbalization of sadness.

An RN is caring for a 20-year-old patient who sustained injuries in a motor vehicle accident. The health care provider just informed the parents that the patient's brain is dead. Which intervention by the RN is most appropriate at this time? 1. Ask the family if the patient has ever discussed organ donation with them. 2. Call the hospice RN to speak to the family about organ donation. 3. If the family doesn't ask if they can donate organs, do not bring it up. 4. Tell the family that if it was your child, you would want to donate the organs as a legacy.

1. Ask the family if the patient has ever discussed organ donation with them. *1) As an RN, one has the skills needed to inform, educate, and support families in the role and need of organ donation. 2) By law, hospice RNs cannot ask the family about organ donation. 3) As an RN, one has the skills needed to inform, educate, and support families in the role and need of organ donation. 4) The personal choice of the RN is not the issue.

When considering the establishment of a to-do list, it should be: 1. readily available and easily accessed. 2. hand written to ensure personalization. 3. created so that frequent revision is not necessary. 4. reviewed mid-shift to evaluate completion of goals.

1. readily available and easily accessed. The list is effective only when it is available and easily accessed; otherwise, it is not likely to be used. The other options are not true since electronic devices can be very effective and personalized, while the list should be reviewed at the end of shift for the purpose of assessing goal achievement.

The most likely reason a 9-year-old child cries and refuses to cooperate with an injection is: 1. the child's past experiences with injections. 2. the environment the child finds himself in, such as a hospital emergency room. 3. the precipitating event, such as a fall that resulted in the need for a local anesthetic. 4. the nurse's verbal and nonverbal communication with the child about the injection.

1. the child's past experiences with injections. Previous experiences with injections are likely to have the greatest impact on the way a child will interpret any communication about an injection.

During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting: a. assertive communication. b. active listening. c. empathy. d. passive communication.

b. active listening. In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.

The nurse is demonstrating active listening when: a. while assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." b. eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. he or she states, "I know how you feel, I recently lost my father and I am still hurting." d. cultural values are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."

b. eye contact is maintained while focusing on the patient as the patient describes the current pain level and location.

A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy? a. "Research is identifying many risk factors for cancer besides smoking." b. "I understand how you could feel angry about the diagnosis." c. "He is still a good husband." d. "Why do you think he got cancer?"

b. "I understand how you could feel angry about the diagnosis." The nurse is placing herself in the wife's position and sharing her emotions.

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations? a. Blocking b. Filtration c. Empathy d. False assurance

b. Filtration Filtration is the unconscious exclusion of extraneous stimuli in communication.

An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a. "You are just too late for that. Where were you when he needed you?" b. "Did you ever consider purchasing a cell phone for your dad to prevent this from happening?" c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." d. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."

c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person.

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

c. Tell me what day of the week today is. The patient must be able to name the day of the week rather than use answer yes or no.

An adolescent client is admitted to the emergency department with a fever. None of the client's family members are present, and the client is tearful and withdrawn. Which of the following statements made by the nurse is an example of therapeutic communication? a. "I know you are frightened, but we will find out what is wrong with you soon." b. "Let me show you around so that you are less frightened." c. "Tell me why you are so frightened." d. "You look frightened."

d. "You look frightened." This answer demonstrates an empathetic and caring attitude where the nurse is addressing nonverbal behavior in an open and honest manner. Answer A diminishes the value of the client's feelings and is giving false reassurance. Answer B, the nurse is making an assumption the client is tearful and withdrawn because he or she is in a strange environment. Answer C isn't correct because "why" questions may make a client defensive.

Which actions demonstrate a nurse's understanding and implementation of QSEN's competencies? Select all that apply. 1. Shares a patient's religious food preferences with members of the health care team 2. Asks for assistance when transferring a large patient onto a stretcher 3. Encourages a patient newly diagnosed with terminal cancer to talk about their end-of-life concerns 4. Deviates from facility's hand hygiene practice policy only when caring for noninfectious patients 5. Attends an in-service on a piece of equipment new to the unit

1. Shares a patient's religious food preferences with members of the health care team 2. Asks for assistance when transferring a large patient onto a stretcher 3. Encourages a patient newly diagnosed with terminal cancer to talk about their end-of-life concerns 5. Attends an in-service on a piece of equipment new to the unit QSEN competencies are demonstrated in the sharing of patient preferences and encouraging the patient to express their needs and values (Patient-Centered Care); Asking for assistance from team members (Teamwork and Collaboration); Learning to use equipment properly (Safety). Deviating from policies and practices based on evidence-based practice without first consulting clinical experts on the subject is clearly not demonstrating EBP.

A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea

b. Past experiences With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated.

In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging

b. Spoken word Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.

Which response by the RN would block therapeutic communication? 1. "How are you doing on your medication?" 2. "I understand you're having second thoughts about the surgery." 3. "Most people don't feel the same as you do." 4. "I'm trying to understand your point of view."

3. "Most people don't feel the same as you do." The RN should use caution when expressing approval or disapproval. It puts the RN in the role of judge, which blocks therapeutic communication.

A patient is deciding if she should move forward with an invasive cosmetic surgery, how should her nurse help her come to the best decision? Select all that apply 1. Ask, "Have you considered any other options?" 2. Provide a story about a patient who did this surgery and was happy. 3. Ask, "How will you discuss the surgery your family or friends?" 4. Ask, "Why are you second guessing yourself now that you're so close to what you want?"

1. Ask, "Have you considered any other options?" 3. Ask, "How will you discuss the surgery your family or friends?"

An RN is planning care for a patient who has an emotional disability. Which educational strategies would best apply to this situation, to improve communication between the RN and the patient?(Select all that apply.) 1. Give the patient clear written and oral information. 2. Highlight significant information for easy patient reference. 3. Speak slowly and deliberately to the patient. 4. Use proper medical terminology in all instructions for the patient. 5. Provide large-print materials

1. Give the patient clear written and oral information. 2. Highlight significant information for easy patient reference. *1) When an RN is working with individuals who are physically, emotionally, or cognitively impaired, the educational strategy is to give precise information, with highlighting, for easy reference. *2) See 1) 3) This technique is directed at working with a patient who is hearing impaired. 4) Instructions should be given in layperson's terminology, so that they are easily understood. 5) Unless the patient is visually impaired, this would not be necessary.

What observations made by the nurse manager, indicates that a nurse demonstrated positive conflict management interventions when a patient's family member angrily accuses the nurse of neglecting the patient's need to be ambulated more frequently? Select all that apply. 1. Moved the discussion to the privacy of the patient's room 2. Kept culturally appropriate eye contact with the family member while discussing the issues 3. Shared that the patient often refuses to ambulate when the offer is made 4. Suggested the family member discuss their concerns with the nurse manager 5. Kept refocusing the discussion to the patient's needs associated with ambulation

1. Moved the discussion to the privacy of the patient's room 2. Kept culturally appropriate eye contact with the family member while discussing the issues 5. Kept refocusing the discussion to the patient's needs associated with ambulation Positive conflict management interventions include those that prevent the situation from escalating while being open to the family member's concerns. Providing privacy, showing attention by keeping eye contact when culturally appropriate, and focusing on the issue identified as the problem will contribute to the resolution of the conflict. Offering excuses and deflecting the discussion will be viewed as negative behaviors by the family member.

Match the following conflict manage styles with their definition. 1. One person puts aside his or her goals to satisfy the other person's desires. 2. One person achieves his or her own goals at the expense of the other person. 3. One person uses passive behaviors and withdraws from the conflict; neither person is able to pursue goals. 4. Both people actively try to find solutions that will satisfy them both. 5. Both people give up something to get partial goal attainment. Compromise Accomodation Collaboration Avoidance Force

1. One person puts aside his or her goals to satisfy the other person's desires - Accommodation 2. One person achieves his or her own goals at the expense of the other person - Force 3. One person uses passive behaviors and withdraws from the conflict; neither person is able to pursue goals. - Avoidance 4. Both people actively try to find solutions that will satisfy them both. - Collaboration 5. Both people give up something to get partial goal attainment. - Compromise

A 70 year old man had a heart attack and was resuscitated. After waking with several broken ribs and in severe pain the man decided that he does not want to go through this situation again. The patient decides he wants to sign a DNR, but the family of the patient thinks that the patient is making a rash decision. What should the nurse do? 1. Order the necessary forms for the patient. 2. Talk to the patient from the family's perspective. 3. Wait until the family is gone and talk to the patient about different options. 4. Ask a doctor to talk to the patient.

1. Order the necessary forms for the patient. It is the nurse's moral responsibility to honor the patient's right to autonomy and allow the patient to sign a DNR.

A patient admitted with a fractured femur who will have surgical repair in the morning reports excruciating pain at the moment, and asks the RN if it will be less after surgery. Which interventions will be most effective to manage this situation? (Select all that apply.) 1. Teach the patient to use a 0 to 10 numeric pain scale. 2. Medicate the patient for pain, per order. 3. Encourage the patient to relax and not worry. 4. Reposition the patient into a less painful position. 5. Teach the patient that anesthesia will help with pain after surgery.

1. Teach the patient to use a 0 to 10 numeric pain scale. 2. Medicate the patient for pain, per order. 4. Reposition the patient into a less painful position. *1) Teaching a pain scale will assist with ongoing assessment. *2) The patient should be medicated to manage current pain. 3) Telling a patient not to worry is not therapeutic. *4) Repositioning the patient will help manage pain. 5) The patient will receive pain medication after surgery. The anesthesia will assist during surgery.

Match the following actions with the appropriate responsibility regarding the delegation of nursing interventions. 1. UAP's statement, "I'll notify you of Mr. Smith's BP as soon as I take it so you can decide whether he gets his medication." 2. RN discusses the way the LPN handled a patient complaint 3. RN initially observes a newly hired LPN is changing a simple dressing Evaluation and reassessment Effective communication Appropriate supervision

1. UAP's statement, "I'll notify you of Mr. Smith's BP as soon as I take it so you can decide whether he gets his medication." Effective communication 2. RN discusses the way the LPN handled a patient complaint Evaluation and reassessment 3. RN initially observes a newly hired LPN is changing a simple dressing Appropriate supervision

An RN plans to incorporate spirituality into clinical practice. What action by the RN is the most appropriate way to integrate spirituality? 1) Tells all patients that prayer will help them through this difficulty journey. 2) Listens when the patient reflects on the progression of this illness. 3) Explains to patients that imagery can take them to a different place. 4) Instructs patients to practice breathing techniques to assist in relaxation.

2) Listens when the patient reflects on the progression of this illness. 1) The RN tells the patient that prayer would help them through this difficult journey. Clarifying the patient's understanding of and need for prayer is part of the holistic journey. The RN is telling the patient what he needs versus identifying what the patient believes regarding prayer. *2) The RN listens to the patient discuss their difficult journey that has brought them here. It is wise to remember that merely the process of listening to and appreciating self-reflection of another nurtures the spirit and acknowledges the spiritual dimension of that person. This action allows the patient to be in control versus the RN. 3) The RN explains to the patient that imagery can take them to a different place. Imagery can take a person to a temple, an ocean, a place of religious worship, a break nook, or any "sacred place" that is, a life giving and healing place for the patient. The RN should offer this as an option versus just telling the patient about imagery. 4) The RN instructs the patient the practice breathing techniques to assist them to relax. The relaxation response and prayer have been demonstrated to affect illnesses. The RN should ask the patient if they would like to try breathing techniques to assist them in relaxing.

Which statement by an RN demonstrates appropriate communication strategies when providing end-of-life care to a patient and his family? 1. "You should know from being with your mother when someone dies. 2. ""Tell me about your feelings." 3. "I promise that I will be here when you die." 4. "I am not allowed to discuss your prognosis."

2. ""Tell me about your feelings." 1) It is not appropriate to assume the patient knows what to expect in the last hours of life. *2) This is an appropriate communication strategy that lets the patient know the nurse is available to talk about feelings, death, or what to expect. 3) Even though all nurses would like to be with patients when they die, they do not know when this will happen, so they cannot make promises. 4) Although a nurse may feel uncomfortable discussing a prognosis, in most cases the nurse is allowed to.

Which is the best assessment for an RN to carry out with a 4-year-old patient to determine the exact location of severe abdominal pain? 1. Ask the patient to draw a picture of the pain. 2. Have the patient point to where the pain is felt. 3. Observe for nonverbal behaviors such as guarding. 4. Ask the parent for assistance in locating the pain.

2. Have the patient point to where the pain is felt. 1) A 4 year old's concept of body image and boundaries are poorly developed. *2) A 4 year old is able to communicate by pointing to a specific area. 3) A 4 year old responds to pain with grimacing, rocking, rubbing, and aggressive behavior, not with guarding. 4) The 4 year old is able to communicate about the pain and is the best source of information.

Which nursing action conveys attentive listening? 1. The RN interrupts the patient for clarification. 2. The RN responds to verbal and nonverbal behavior. 3. The RN states, "I know what you are going through." 4. The RN states, "I can talk with you for five minutes."

2. The RN responds to verbal and nonverbal behavior. 1) While asking for clarification is appropriate, interrupting the patient does not convey caring. *2) Attentive listening uses all the senses. Thus, the attentive listener absorbs information from both verbal and nonverbal behavior, from what is seen and sensed as well as the words that are heard. 3) This statement implies that the RN's experience is comparable to the patient's, and may be perceived as minimizing what the patient is going through. 4) Attentive listening takes time, because of the energy and concentration required. Placing a limit of five minutes on conversation conveys to the patient that the RN has time for only a routine, quick exchange of information.

Which statement by the RN best teaches an older adult about safety issues related to driving? 1. Do not drive at night because the response time is slower at that time. 2. Turn the head side to side before changing lanes to compensate for decreased peripheral vision. 3. Drive five miles under the speed limit to accommodate for diminished reaction time. 4. Allow extra time to turn the steering wheel to compensate for reduced muscle mass.

2. Turn the head side to side before changing lanes to compensate for decreased peripheral vision. 1) Many elders can drive safely for several years. One cannot make such a blanket statement concerning all elders. *2) Peripheral vision is diminished in elders. 3) Driving more slowly than the prevailing traffic will not address the problem of diminished reaction time. Furthermore, it can be hazardous. 4) Elders may have decreased muscle mass, but this should not affect turning the steering wheel.

A 4-year-old patient, recently diagnosed with autism, is being referred to an early intervention program. Which educational strategies would the RN recommend be used with this patient in this situation? (Select all that apply.) 1. Base information and teaching on chronologic age. 2. Use nonverbal cues, gestures, signing, and symbols as needed. 3. Use simple explanations and concrete examples with repetition. 4. Discourage active participation. 5. Encourage return demonstrations.

2. Use nonverbal cues, gestures, signing, and symbols as needed. 3. Use simple explanations and concrete examples with repetition. 5. Encourage return demonstrations. 1) When educating people with developmental disabilities, it is recommended to base information and teaching on developmental stage, not chronologic age. *2) When educating people with developmental disabilities, it is recommended to use nonverbal cues, gestures, signing, and symbols, as needed. *3) When educating people with developmental disabilities, it is recommended to use simple explanations and concrete examples with repetition. 4) When educating people with developmental disabilities, it is recommended to encourage active participation. *5) When educating people with developmental disabilities, it is recommended to demonstrate information, and have the person perform return demonstrations.

A home health care RN is caring for an older adult. Which activity demonstrates the patient is adapting to independence? 1. Completing daily crossword puzzles to stimulate thinking 2. Using an electric can opener because of difficulty operating manual opener 3. Doing daily range of motion exercises on all extremities 4. Increasing protein in the diet for improved muscle building

2. Using an electric can opener because of difficulty operating manual opener 1) Completing a crossword puzzle is not an adaption to independence. This is a strategy to promote cognitive function. *2) Demonstrating the use of an electric can opener for a patient who can no longer use a manual one will enable the patient to lead a more independent lifestyle. 3) Range of motion exercise promotes mobility, but is not an example of adaptation to independence. 4) Increased protein will promote healthy nutrition, but is not an adaptation to independence.

The most important concept to remember when using both verbal and nonverbal communication is that: 1. people are more likely to accept verbal messages than nonverbal ones. 2. nonverbal messages are accepted as true more often than verbal ones. 3. touch as a nonverbal form of communication should be avoided. 4. avoiding eye contact is viewed as being untruthful by all cultures.

2. nonverbal messages are accepted as true more often than verbal ones. An important concept to remember is that when the verbal message and the nonverbal message do not agree, the receiver is more likely to believe the nonverbal message since body language is often the most trusted indicator for conveying feelings, attitudes, and emotions. Touch is appropriate and useful when accepted by the client. In some cultures, avoiding eye contact is viewed as being respectful.

When focusing on maintaining emotional energy, the nurse should focus on personal: 1. reality checks. 2. self-confidence. 3. balance between work and rest. 4. flexibility.

2. self-confidence. Self-confidence, self-control, and interpersonal effectiveness are all key to emotional intelligence and energy. Physical energy relates to balance, while flexibility is key to mental energy. Reality checks help maintain spiritual energy.

In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? 1 Nurses understand the principle of autonomy to guide respect for patient's self-worth. 2 Nurses have a scope of practice that encourages their presence during ethical discussions. 3 Nurses develop a relationship to the patient that is unique among all professional health care providers. 4 The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

3 Nurses develop a relationship to the patient that is unique among all professional health care providers.

During a visit to the family home of a 5-year-old child who has been diagnosed with asthma, an RN notices cockroaches in the kitchen and explains that cockroaches are a major asthma trigger for many children. Which would be the appropriate follow up response by the RN in this situation? 1. "I see you leave food out on your counter. You need to make sure no food is left out, so you won't get cockroaches." 2. "Did you know that cockroaches make your child's asthma worse?" 3. "I can help you find an exterminator to rid your home of cockroaches." 4. "I'll be visiting again in one week. Please make sure the cockroach situation is under control by then."

3. "I can help you find an exterminator to rid your home of cockroaches." 1) This statement blames the family for their situation. This is an opportunity for patient education, not blame. 2) This statement blames the family for their situation, as well. *3) The home should be assessed for pertinent environmental factors and available community resources should be identified to rid the home of pests. 4) This is a nontherapeutic statement. The family might feel threatened and refuse to have the RN come back into the home.

Which statement made by the patient after teaching allows the RN to determine that the patient understood the course of a chronic illness? 1. "I'll be glad when I return to normal." 2. "I know that I will never get better." 3. "I know how unpredictable this can be." 4. "I don't understand why this happened to me."

3. "I know how unpredictable this can be." 1) Chronic illness is defined as a long-term illness. The patient may still have an acceptable quality of life, but does not return to pre-illness conditions. 2) A person learns to live with their chronic illness and the limitations imposed. Symptoms can be controlled and complications may be prevented. *3) Symptoms are unpredictable with chronic illness and the individual needs to cope with the changes in their lifestyle. 4) This person is still in the denial stage of the illness and needs counseling to learn to cope with the condition.

An RN who is working with a group of older adults is teaching techniques to promote medication safety. Which statement made by the older adult indicates the teaching was ineffective? 1. "My daughter gave me a large pill organizer that I fill weekly." 2. "I have a list of all my over-the-counter drugs in my purse." 3. "My daughter knows the reason why I take each of my medications and I think that's OK." 4. "I get all of my medications from the same pharmacy."

3. "My daughter knows the reason why I take each of my medications and I think that's OK." 1) Pill organizers increase safety. 2) A list of all medications increases safety. *3) The patient, not a relative, needs to know details about the medications. 4) Use of a single pharmacy increases safety.

A frail elderly client has decided that he does not want any more surgeries, but his family and surgeon insist he continue these surgeries. Which of the following is an example of caring-based reasoning? 1. "This surgery, which he may not even survive, will cause him to suffer more and his family will feel guilty later." 2. "This is violating this clients right to autonomy, this man has a right to choose what happens to his body." 3. "My relationship with this man makes me want to protect him; I must help his family understand his needs." 4. "If this man doesn't want the surgery, we shouldn't do it, he may die from the surgery and it will be a waste."

3. "My relationship with this man makes me want to protect him; I must help his family understand his needs." Caring-based reasoning stresses courage, generosity, commitment, and the need to nurture and maintain relationships.

Which statement demonstrates a problem in a nurse's attitude regarding the need to change? 1. "Tell me what needs to be changed." 2. "Why does this need to be changed?" 3. "This has always worked; it doesn't need to be changed." 4. "What makes changing so very difficult to achieve?"

3. "This has always worked; it doesn't need to be changed." A person cannot affect a change on an experience if he or she is not willing to do something differently that could adjust the outcome. The other options do not demonstrate an unwillingness to change.

When a client expresses doubt whether a complicated procedure will actually help his condition, the nurse best avoids blocking the communication by responding: 1. "I can understand your concern. We can talk more about it whenever you want." 2. "Your physician has performed this procedure many times and with great success." 3. "What makes you doubt that your condition will benefit from having the procedure done?" 4. "Would you like me to arrange for someone who has had the procedure talk to you about it?"

3. "What makes you doubt that your condition will benefit from having the procedure done?" By opening the communication up to further discuss the client's concerns, the nurse has validated the client's feelings, acknowledged his concerns, and provided the opportunity for further communication. The other options, while providing support and encouragement, do not open communication for further information gathering.

How can a nurse manager best foster high-quality and safe nursing care among the nursing staff? 1. Praise the staff's efforts to provide care that is both safe and of high quality 2. Offer incentives to those providing specific interventions that are safety and quality focused 3. Create a unit culture where asking questions about health care interventions is encouraged 4. Place great emphasis on how important safe, high-quality nursing care is to the client's health

3. Create a unit culture where asking questions about health care interventions is encouraged Health care organizations focusing on quality and safety encourage inquiry, making it okay to ask questions and providing resources to access information needed through various means, including informatics. Although praise and incentives are appropriate, they are not effective if the unit culture is not accepting. Placing emphasis on such interventions alone will not be successful if not supported by nursing managers and leaders.

Place the following activities in the proper sequence in order to best achieve the development of a professional communication style. 1. Understanding the influence gender, cultural, and age has on the communication process 2. Recognize one's personal use of negative communication techniques like blocking 3. Developing an effective personal conflict management style 4. Avoiding the use of negative communication techniques like cognitive distortions 5. Adopting the use of "I messages," conveying empathy, and open communication techniques

3. Developing an effective personal conflict management style 4. Avoiding the use of negative communication techniques like cognitive distortions 2. Recognize one's personal use of negative communication techniques like blocking 5. Adopting the use of "I messages," conveying empathy, and open communication techniques 1. Understanding the influence gender, cultural, and age has on the communication process

A family is anticipating the loss of a child who is terminally ill. The RN has identified the priority nursing diagnosis statement as Powerlessness related to poor outcomes from medical treatments. What is the best expected outcome for this family? 1. Family members will acknowledge impact of loss prior to the child's death. 2. Family members will identify means to strengthen existing coping skills. 3. Family members will plan an activity to share with the child in the hospital. 4. Family members will gather daily to interact with one another.

3. Family members will plan an activity to share with the child in the hospital. 1) While important, this expected outcome addresses anticipatory grieving. "Acknowledging impact" is a nonmeasureable behavior. Few parents reach acceptance by the time of a child's death. 2) This expected outcome addresses the problem of ineffective coping. The expected outcome requires specificity in timeline. *3) Participation in planning of care will provide an aspect of control and decrease feelings of powerlessness. 4) The focus of this expected outcome is on improving the strained family processes caused by the illness of the child.

A patient who is diagnosed with a terminal cancer and was instructed by a physician to start chemotherapy. What is the most appropriate question that the advocate should ask the patient? 1. Are you aware of the side effects of chemotherapy? 2. Can I share my story as a breast cancer survivor? 3. How do you feel about your decision? 4. Do you want to know your prognosis?

3. How do you feel about your decision? Asking the patient to clarify his/her perspectives and values. Asking about the patient's feeling will initiate a dialogue and the advocate will truly find out what's most important value in the patient's care plan.

A patient who has diabetes mellitus (type 1) reports drinking a ginseng preparation, as directed by their faith healer. Which action by the RN should be taken next in this situation? 1. Warn the patient of the physiological effects of ginseng. 2. Encourage the patient to stop taking the ginseng preparation. 3. Urge the patient to mention the use of ginseng to the health care provider. 4. Tell the patient to continue drinking the ginseng preparation as long as it seems to help.

3. Urge the patient to mention the use of ginseng to the health care provider. 1) Folk healers use ginseng to reduce stress, increase energy, and promote digestive health. The RN should not show distrust in the faith healer, as the RN would then lose the trust of the patient. 2) To tell the patient to stop taking the herb would affect the patient's belief in the faith healer and might drive the patient away from the care prescribed, as well. *3) This patient has a naturalistic belief and they use herbs in the treatment of an ailment. The RN needs to accommodate the patient's belief and also advocate the treatment by modern health science. The RN should inform the patient to tell the health care provider that they are taking herbs. 4) The health care provider needs to know the herbs that the patient is taking, because the herbs may alter or interfere with modern day medicine.

The adult relative of a patient who is hearing-impaired expresses frustration because of the difficulties experienced in communicating with the patient. Which guidelines for communicating would be appropriate for the RN to provide to the relative? (Select all that apply.) 1. Talk directly toward the most impaired ear. 2. Speak loudly, using short phrases. 3. Use appropriate gestures. 4. Avoid speaking with anything in your mouth. 5. Limit environmental noise.

3. Use appropriate gestures. 4. Avoid speaking with anything in your mouth. 5. Limit environmental noise. 1) If hearing is worse in one ear, one should speak toward the ear which is less impaired. 2) Loudness/shouting distorts speech and inhibits understanding; simple words with longer phrases aid comprehension. *3) Gestures provide visual clues to meaning. *4) Holding something in the mouth or chewing gum interferes with clear articulation and impedes understanding. *5) Background noise increases hearing difficulty.

The primary goals of good relationship building and client care are best achieved when all members of the interprofessional care team: 1. have identified the team's leader. 2. are experts in their field of care. 3. have developed a trusting relationship. 4. recognize their role in the client's care.

3. have developed a trusting relationship. The need for trust in the health care setting is not limited to the nurse-patient relationship but rather pervades all working relationships. Care is more effective when the nursing team and the interprofessional team share the essential element of trust. Although the other options are factors in relationship building and client care, they would all be affected by a lack of trust among team members.

After first having a strong understanding of the standards of practice that govern delegation, the registered nurse must know the: 1. patient care tasks that are being considered for delegation. 2. expected outcomes of the care to be delegated. 3. the condition and needs of the patient whose care is being delegated. 4. skill and knowledge level of the staff member who is being delegated to.

3. the condition and needs of the patient whose care is being delegated. The RN must then know the client whose care is being delegated. The client's condition and stability must be determined before tasks and outcomes can be determined or consideration be given to the skill level of the staff being delegated to.

Which statement made by an unlicensed assistive personnel (UAP) would cause the registered nurse team leader the most concern? 1. "The nurse will follow up to make sure the client is well cared for." 2. "I wonder who I can ask about how to use this new electronic thermometer." 3. "I've only been working on this unit for a month and things are still new to me." 4. "It's good to know that the nurse is really the one responsible for the client's care."

4. "It's good to know that the nurse is really the one responsible for the client's care." The UAP is responsible for his or her own actions. A belief that the nurse is fully responsible is a concern and needs immediate attention by the nurse. It is true that the nurse will follow up and evaluate the client's care. The statements concerning being new and asking for help are appropriate.

A health care provider tells a 30-year-old patient that their biopsy that was just taken indicates lung cancer. The patient says to the RN, "This can't be true. I've never smoked a cigarette." Which statement by the RN would be most appropriate for this stage of grieving, according to Kübler-Ross? 1. "It is normal for you to withdraw from family when you accept this diagnosis." 2. "Anger is commonly associated with grief in this situation." 3. "It is normal to be sad when you hear this type of news." 4. "Tell me what this new information means to you."

4. "Tell me what this new information means to you." 1) Acceptance allows the person to take time to come to terms with the present reality. Some patients may withdraw. 2) Anger is a feeling of rage with unrealistic struggle against the real problem. It is also directed against self, if negative lifestyle is the cause. That, however, is not the case here. 3) Depression occurs after the news has set in, and the individual usually feels overwhelmed. *4) Denial at this time can be an adaptive response, providing a buffer after bad news. Open-ended questions provide an opportunity for expression of feelings.

Which question should be most effective in assessing a patient's response to hospitalization? 1. "Are you upset about being in the hospital?" 2. "Is this the first time you have been hospitalized?" 3. "Is it difficult for you to be in the hospital?" 4. "What are your feelings about being in the hospital?"

4. "What are your feelings about being in the hospital?" 1) This question suggests a feeling to the patient and is not the best question to ask. Also, the patient can answer this question with a 'yes' or 'no' response. 2) This question can be answered 'yes' or 'no' and does not focus on the patient's feelings or response. 3) See 2). *4) This is a broad opening or general lead question that requires the patient to answer with more than one or two words and encourages the exploration of feelings.

Which question will best help an RN determine a family's ability to provide for a patient with mild dementia? 1. "What is your understanding of your parent's illness?" 2. "Do you think your parent will be safe living alone at home?" 3. "Which of you is willing to be responsible for coordinating care?" 4. "What role do each of you expect to take in caring for your parent?"

4. "What role do each of you expect to take in caring for your parent?" 1) This does not provide information about the family's roles or expectations for care. 2) This is a closed ended question that will give little information about the family's ability to provide care. 3) This provides information only about one family member, and is not helpful in determining who would be best to assume this role. *4) This question gives each family member the opportunity to express their expectations and begins the process of identifying the level of support each family member can provide.

A 6-year-old child has recently been diagnosed with asthma. Asthma management education is to be provided to the family and the child. Which would be the best setting for this to occur? 1. At the health care provider's office 2. At the child's school 3. At the hospital, prior to discharge 4. At the family's home

4. At the family's home 1) It may be difficult for the family to arrange time to travel to the health care provider's office. Several other factors need to be considered as well: transportation, child care issues, work schedules, and insurance reimbursement. 2) See 1). In addition, teaching should include the entire family, which might not be possible in a school setting. 3) Even if the child was hospitalized, the entire family needs to be educated and it should be geared toward the environment in which the child lives. *4) Health teaching in the home allows for one-to-one teaching in a private setting and allows for inclusion of all family members. In addition, the time could be arranged for the convenience of the family, not the health care provider.

A patient asks the RN, "Do you think I should tell my spouse about my illness?" The RN responds, "You seem unsure about telling your spouse you are ill." Which communication technique is the RN using? 1. Acknowledging 2. Clarifying 3. Focusing 4. Restating

4. Restating 1) Acknowledging is a technique that simply identifies that communication has occurred; it is not a restatement of ideas. 2) Clarifying helps both participants identify differences in their frames of reference and gives them the opportunity to correct misperceptions. 3) The statement does not reflect focusing, which is a valuable technique for patients who are resistant or guarded. *4) The RN is restating to summarize the patient's message and convey it was received and understood.

An RN is assessing the health status of an elder patient. Which of the following statements about the patient by the family member should trigger the RN's concern about hearing loss? 1. Increasingly accepting of new people 2. Speaks clearly with accurate enunciation 3. Increased interest in local and national politics 4. Tends to talk all the time

4. Tends to talk all the time 1) Hearing loss is most often accompanied by suspiciousness of new people and social withdrawal. 2) Speech deterioration is associated with hearing loss and may include slurring of words, dropping word endings, and flat sounding speech. 3) Indifference and social withdrawal are typical manifestations of hearing loss. *4) Tendency to dominate the conversation may be an indication of hearing impairment. Hearing impaired persons may dominate a conversation in an attempt to control it, and therefore deny hearing loss.

A patient with a chronic illness says to the RN, "You know I'm not sick now. I feel better each day." How should the RN interpret the patient's statement? 1. The patient is assuming the role of being sick. 2. The patient is using rationalization to deal with the illness. 3. The patient sees themselves as the same as others without chronic illness. 4. The patient sees themselves as sick only when the disease interferes with their daily functioning.

4. The patient sees themselves as sick only when the disease interferes with their daily functioning. 1) Patients assume the role of being sick when the symptoms are affecting their ability to function in their normal capacity. 2) While some patients use rationalization to deal with illness, the example given in this does not illustrate the use of rationalization. 3) This statement indicates that the patient is in the stable phase of a chronic illness, that symptoms are currently under control. *4) Patients who have adapted to their chronic illness view themselves as sick only when the symptoms interfere with their ability to function on a daily basis.

When assessing the significance of a loss for a patient, who does the RN expect to provide the most significant data? 1. The spouse of the patient experiencing the loss 2. The adult children of the patient experiencing the loss 3. The primary caregiver for the patient experiencing the loss 4. The patient who is experiencing the loss

4. The patient who is experiencing the loss 1) Although this is plausible and spouses often try to rate the patient's pain level and significance of a loss, this should only be used if the patient is unable to answer for themselves. 2) Although this is plausible and adult children may want to rate the patient's pain level and significance of a loss, this should only be used if the patient is unable to answer for themselves. 3) Although this is plausible and caregivers may think they are able to rate the patient's pain level and significance of a loss, this should only be used if the patient is unable to answer for themselves. *4) As with pain, fatigue, and other symptoms, we have learned it is important for health care professionals to obtain the patient's own perception of the significance of the loss.

A patient in a long term facility who is legally blind has a nursing diagnosis statement of Social Isolation related to inability to see. The RN should give priority to which outcome? 1. The patient will identify activities of interest on the social calendar. 2. The patient will ask for assistance when ambulating. 3. The patient will wear corrective lenses. 4. The patient will participate in one unit activity every day.

4. The patient will participate in one unit activity every day. 1) Identifying activities of interest does not guarantee the patient will participate in them. 2) Asking for assistance when ambulating is important for safety, but it does not directly impact social isolation. 3) Wearing lenses does not correct the vision in a patient who is legally blind. *4) Participating in activities will address social isolation.

The nurse cares for a successful chemical engineer, age 29 years, who is admitted with a respiratory infection. The client reports feeling more stress than ever since a job promotion six months ago and asks, "Why would something so positive and wonderful cause so much stress for me?" Which is an appropriate response by the nurse? [Select all that apply.] A. All major life events can cause stress for us. B. People vary greatly in their perception of what constitutes as a crisis or stressor. C. Your job promotion probably has nothing to do with the stress you feel. D. Positive life events do not cause stress or illness. E. Even positive life events can affect us in negative ways.

A. All major life events can cause stress for us. B. People vary greatly in their perception of what constitutes as a crisis or stressor. E. Even positive life events can affect us in negative ways.

While conducting a health assessment with an older adult, the nurse notices it takes the person longer to answer the questions than with younger patients. What should the nurse do? A. realize that the patient has some dementia B. slow the pace and allow extra time for answers C. ask a family member to answer the questions D. stop asking questions so as not to confuse the patient

B. slow the pace and allow extra time for answers

A nurse tells a patient, "Why won't you get out of bed? Are you always this lazy? This is an example of which of the following barriers to communication? A. using leading questions B. using probing questions C. using judgmental language D. using comments that give advice

C. using judgmental language

A client scheduled for complex heart surgery has been reading the Bible for hours each day, cries often, and is not sleeping well. What might these observations cue the nurse about the client? A. These behaviors are expected before major surgery. B. Family members live far away and the client is lonely. C. These behaviors are signs of spiritual distress. D. The client is naturally emotional and reactive.

C. These behaviors are signs of spiritual distress.

A nurse is dealing with an extremely uncooperative patient who will not take his medicine. What would be an appropriate response? a. Telling the patient, "You have to take your meds. It's what the doctor ordered, and it is in your best interest." b. Crushing the meds in the patient's food so that he gets them anyway, because he really needs to take them to get better. c. Informing the patient of the possible ramifications of not taking his meds, but accepting that he does not have to take them if that is his decision. d. Telling another nurse not to force the patient to take his meds because it is his decision not to take them. And, if he does not care about getting better why should his nurses.

c. Informing the patient of the possible ramifications of not taking his meds, but accepting that he does not have to take them if that is his decision. Choice (a) violates the essential nursing value of autonomy. Choice (b) violates the essential nursing value of integrity. Choice (d) violates the essential nursing value of altruism.

A 75 year old woman with ovarian cancer rejects radiation and chemotherapy treatments, because she fears their effects. She wants to only pursue a natural, holistic treatment, because she believes it is the least painful option. What nursing action would be most helpful? a. Honoring the client's decision and not interfere with her choice to avoid a painful treatment. b. Helping her research the most effective, holistic treatments and choosing the best option. c. Verifying the client has accurate information and understands the consequences of her decision. d. Informing the client that radiation and chemotherapy are the best options for her survival.

c. Verifying the client has accurate information and understands the consequences of her decision. Nurses need to help clarify client's values by examining the possible consequences of their choices; make sure the client has thought about possible results of each action. a. The client may not have accurate information. Not providing accurate information would be violating nonmaleficence. b. and d. These actions would be imposing the nurse's values on the client, which should never be done.

A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating: a. open communication. b. filtration. c. blocking. d. false assurance.

c. blocking Blocking occurs when the nurse responds with noncommittal or generalized answers.

A nurse observes a client crying as he reads from his devotional book. What intervention by the nurse would be the most appropriate? a. contact the hospital's spiritual services b. inquire as to what is making him cry c. provide quiet times for these moments d. turn on the television for a distraction

c. provide quiet times for these moments Providing privacy and time for the reading of religious materials supports the spiritual health of the client. Asking the client about crying or providing a distraction could be interpreted as being disrespectful of the client's beliefs.

A client and her husband used in vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives. She asks that the sperm be destroyed because her husband's faith prohibited remarrying, and allowing another person to use the sperm would conflict with her late husband's beliefs. The nurse realizes that: a. the client is in the second step of ethical decision making and that the client's value system is influencing her choices of alternative actions. b. a logical line of reasoning has led to validation of the decision to destroy the husband's sperm. c. the client has not been able to navigate the complicated issues inherent in this situation. d. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband.

d. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband. After completing all steps in the situation assessment procedure, the client is now ready to justify her selection. In this phase, the person will specify reasons for the action, will clearly present the ethical basis for these reasons, will understand the shortcomings of the justification, and will anticipate objections to the justification.