Fundamentals of Nursing Ch 20 PrepU 4
The nurse considers which client aspect as nonverbal communication? a. The client's accent b. The client's tone of voice c. The client's values and beliefs d. The client's religious practices
b. The client tone of voice Explanation: A person communicates by gestures, facial expressions, posture, space, appearance, body movement, touch, vocal tone, volume, and rate of speech. All are examples of nonverbal communication.
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. Which of the following is the characteristic of empathy? a. Experiencing feelings similar to that of the client b. Conveying genuine care to the client c. Caring for the client without negative judgement d. Identifying with the client's feelings
d. Identifying with the client's feelings Explanation: Empathy is the ability to identify with client feeling. Congruence refers to feelings that match the expressions of the client. Positive regard means conveying genuine care to clients without passing any negative judgment on them.
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out? a. developing solutions that are enacted b. attending to physical health care needs c. establishing trust and rapport d. reviewing health changes
d. reviewing health changes Explanation: During the termination phase of the nurse-client relationship, the nurse and the client review health changes and how the client has dealt with physical and emotional responses. During the orientation phase of the nurse-client relationship, the nurse and client work toward establishing trust and rapport. During the working phase of the nurse-client relationship, the nurse attends to the physical health care needs and develops solutions that are acted upon by the client.
While assessing a client, the nurse notices that the client seems to be distracted from the questions being asked. The nurse attempts to identify factors that may be affecting the communication. What would the nurse identify as an internal influencing factor? a. Experience b. Privacy c. Noise d. Ambience
a. Experience Explanation: The client's past experience, an internal influence, may affect the nurse-client communication. Noise, privacy, and ambience are external factors that affect the communication between a nurse and client. Other internal influences that may affect the nurse-client communication are cultural background and beliefs.
During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking, "How many times have you been hospitalized this year for your back pain?" This is an example of which type of question? a. Closed question b. Open-ended question c. Sequencing question d. Reflective question
a. Closed question Explanation: An open-ended question is often used when the nurse is obtaining a nursing history and allows the client to reply with a wide range of possible responses, thus encouraging free verbalization. A closed question is answered by one or two words, often "yes" or "no." A sequencing question is used to place events in a chronological order and to investigate a possible cause-and-effect relationship. A reflective question involves repeating what the person has said or describing the person's feelings.
A female nurse states the following to another nurse who is constantly forgetting to wash her hands between patients: "It looks like you keep forgetting to wash your hands between patients. It's really not safe for your patients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech? a. Therapeutic b. Agressive c. Nonassertive d. Assertive
b. Assertive Explanation: The communication is an example of assertive speech. Assertive communication is the ability to stand up for oneself and others using open, honest, and direct communication. Aggressive communication involves asserting one's rights in a negative manner that violates the rights of others. Therapeutic speech is speech that has a specific purpose or goal between the nurse and the client. Nonassertive speech would be the opposite of assertive speech as described above.
An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse she is afraid of waking up during surgery. The best response by the nurse is to: a. state "everyone is afraid of that." b. ask the client why she thinks she will wake up during surgery. c. ask the surgeon to come to the bedside to reassure the client. d. look directly at the client and state, "you are afraid of waking up during surgery."
b. ask the client why she thinks she will wake up during surgery Explanation: Making a sweeping generalization that does not necessarily apply to a specific client hinders communication. It also tends to make the person feel as though he or she is just another insignificant being. Restating the client's concern is inappropriate at this time. The surgeon should not be asked to reassure the patient. The nurse could ask the anesthesiologist to speak with the client to help alleviate any fears the client has. Asking the client why she thinks she will wake up during surgery opens the lines of communication.
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. The nurse is the: a. target. b. sender. c. decoder. d. receiver.
b. sender. Explanation: A sender is a person or group with a purpose for the communication.
A client arrives at a crisis center in a state of bipolar mania. The client has a flight of ideas and it is difficult for the nurse to obtain an adequate intake assessment. Which of the following statements or questions will elicit the most specific information? a. "Describe why people in glass houses should not throw stones." b. "What do believe caused this current manic episode?" c. "Tell me about a time in your life when you were happy." d. "Are you allergic to any medications?"
c. "Are you allergic to any medications?" Explanation: The closed question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed questions are used to gather specific information from a client and to allow the nurse and patient to focus on a particular area.
The newly hired nurse is collecting assessment data for an upcoming surgical procedure from a client who speaks English as a second language. Which statement made by the newly hired nurse would indicate to the nurse educator that intervention is needed? a. "You are scheduled for surgery four hours from now." b. "Can you remove your ring, or do you need help?" c. "Do you have any questions about your cholecystectomy?" d. "I will need to draw blood from you before the operation."
c. "Do you have any questions about your cholecystectomy?" Explanation: The nurse should be careful to use lay terminology when speaking with clients unless the nurse knows the client is a health care professional. The client may not understand what a cholecystectomy is. The other questions are appropriate and the client should be able to understand them.
The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. What is the most appropriate response by the nurse to decrease the client's anxiety? a. "I will start an IV, which should not cause you too much pain." b. "I will start an IV, which should not take much time." c. "I will start an IV that will add fluids directly to the blood stream." d. "I will start an IV with the number 18 catheters."
c. "I will start an IV that will add fluids directly to the blood stream." Explanation: The nurse should explain the procedure and its purpose. The nurse telling the client that it should not take much time does not convey the purpose of the procedure. It is unnecessary for the nurse to inform the client about the technical details of the catheter. Additionally, the nurse should not give false reassurance by telling the client that the procedure will not be painful.
In order to provide effective nursing care, the nurse should engage in what type of communication with the client and significant others? a. Therapeutic communication b. Meta-communication c. Interpersonal communication d. Purposive communication
a. Therapeutic communication Explanation: Therapeutic communication facilitates interactions focused on the client and the client's concerns. Therapeutic communication is purposive, but this is not a discrete category of communication.
A nurse is transfusing multiple units of packed red blood cells (PRBCs). After the second unit is transfused, the nurse auscultates bilateral crackles at the bases of the client's lungs and the patient reports dyspnea. The nurse telephones the health care provider and provides an SBAR report. Which of the following statements represents the final step in this type of communication? a. "I think the client would benefit from intravenous furosemide (Lasix)." b. "It seems like this client has fluid volume overload." c. "I am calling because the client receiving blood has developed dyspnea and had crackles." d. "This client has a medical history of heart failure."
a. "I think the client would benefit from intravenous furosemide (Lasix)." Explanation: Situation, Background, Assessment, and Recommendations provides a consistent method for hand-off communication that is clear, structured, and easy to use. This technique was originally developed by the U.S. Navy to accurately transmit critical information and initially adapted by Kaiser Permanente of Colorado to facilitate nurse and physician communication. The S (Situation) and B (Background) provide objective data, whereas the A (Assessment) and R (Recommendations) allow for presentation of subjective information. Calling to report dyspnea and crackles occurs as the nurse describes the situation. Providing the medical history occurs as the nurse offers important background information. Stating the client has fluid volume overload is the assessment of the nurse.
A nurse visits a female victim of sexual assault during which 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. "Tell me more about the aspects that make you feel as if it happened yesterday." b. "In reality, the sexual assault did not occur yesterday; it has been over one month now." c. "Can you do something to alleviate the fear of being assaulted again?" d. "We should move on from the strong feelings associated with this incident."
a. "Tell me more about the aspects that make you feel as if it happened yesterday." 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; it is a non-therapeutic approach. Making the client realize that the rape occurred a month ago would block communication.
When attending a staff meeting, a nurse is participating in what type of communication? a. Small-group communication b. Intrapersonal communication c. Organizational communication d. Interpersonal communication
a. Small-group communication Explanation: A nurse is participating in small-group communication when attending a staff meeting. Small-group communication occurs when nurses interact with two or more people. To be functional, members of the small group must communicate to achieve their goal. Examples of small-group communication include staff meetings, patient care conferences, teaching sessions, and support groups. 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. Interpersonal communication occurs between two or more people with a goal to exchange messages. Most of the nurse's day is spent communicating with clients, family members, and members of the health care team. The ability to communicate effectively at this level influences your sharing, problem solving, goal attainment, team building, and effectiveness in critical nursing roles. Organizational communication occurs when people and groups within an organization communicate to achieve established goals.
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 of the following statements conveys empathy on part of the nurse? a. "Can you please tell me why you are crying?" b. "I know this is hard for you. Is there any way I can help?" c. "Sitting in the dark is not going to cure your cancer. Let's open the curtains." d. "I am so sorry you are going through this. Can we talk?"
b. "I know this is hard for you. Is there any way I can help?" Explanation: Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems, but remains objective enough to help the client work to attain positive outcomes. By retaining this quality, you can establish successful helping relationships without appearing cold or stern. The first statement demonstrates sympathy. Sympathy differs from empathy because it shifts the emphasis from the client to the nurse as he or she shares feelings and personal concerns and projects them onto the patient limiting ability to focus objectively on the client's needs. Asking about why the client is crying is part of information gathering, but is not empathy. Stating that sitting in the dark will not cure cancer is an abrasive statement that may work against the nurse-client relationship.
A nurse is caring for a client admitted to the hospital for dehydration. The physical findings consistent with the diagnosis include: a. slow heart rate and prolonged capillary refill. b. easy wrinkling of the skin and sunken eyes. c. cold intolerance and brittle nails. d. pallor and diaphoresis.
b. easy wrinkling of the skin and sunken eyes. Explanation: Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone. On the other hand, the person in good health tends to radiate his or her healthy status through general appearance. Although prolonged capillary refill is consistent with dehydration, slow heart rate is not. Pallor may be associated with dehydration but diaphoresis is not associated with this condition. Cold intolerance and brittle nails are consistent physiologic changes seen in clients with hypothyroidism.
The nurse is communicating with a client who begins to cry. The nurse places her hand on the client's arm and sits quietly at the client's beside. What mode of communication is the nurse using to offer caring and comfort for the client? a. Body Language b. Visual c. Kinesthetic d. Verbal
c. Kinesthetic Explanation: There are three forms of communication channels including kinesthetic, verbal, and visual. Kinesthetic is the form of touch used to convey emotional support for the client. The verbal mode of communication uses words to relay information, and visual uses gesture or actions to communicate. Body Language is a broad term for non-verbal communication that allows the nurse to observe uncommunicated behaviors of the client and can include several behaviors including: touch, eye contact, facial expressions, posture, gait, gestures, general physical appearance, grooming, sound, and silence.
A nurse has been caring for a client who suffered a myocardial infarction two days ago. During the morning assessment, the nurse asks the client how he or she feels. Which of the following scenarios warrants further investigation? a. The client smiles at the nurse and states, "I cannot wait to go home." b. The client is sitting in a chair and states, "I feel a lot better than I did yesterday. c. The client stares at the floor and states, "I feel fine." d. The client looks at the nurse and states, "I am still not feeling my best."
c. The client stares at the floor and states, "I feel fine." Explanation: It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, a nurse asks the client, "How do you feel today?" and the client responds, "I feel all right." However, the nurse notes the client does not maintain eye contact and his or her facial expression is tense. This would indicate that the nurse should investigate further because of the incongruence of the patient's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication was effective and no further investigation was warranted.
A client arrives at an emergency department after experiencing several black, tarry stools. The nurse will develop a cause and effect by: a. insisting the client not eat or drink anything until further instructed. b. determining if the client has any food or drug allergies. c. asking the client if he or she has recently taken ferrous sulfate (iron) or bismuth subsalicylate (Pepto Bismol). d. asking the client to provide a stool specimen for guac testing.
c. asking the client if her or she has recently taken ferrous sulfate (iron) or bismuth subsalicylate (Pepto Bismol) 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. Asking for a stool specimen will only indicate the presence of blood. Determination of food or drug allergy does not suggest the cause of the black, tarry stools. This client should be NPO; however, that does not inform the cause of the black, tarry stools. Both ferrous sulfate and bismuth subsalicylate can cause darkening of the stool and may be the causative agent.
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? a. seeking clarification b. giving information c. giving false reassurance d. encouraging elaboration
c. giving false reassurance Explanation: False reassurance means giving reassurance that is not based on the real situation. It is a way of minimizing the client's situation and violates the client's trust. Seeking clarification means helping the client put unclear thoughts or ideas into words. Giving information involves sharing accurate information about the client's health and well-being in a timely manner. Encouraging elaboration is a technique used to help the client describe more fully the concerns or problems being discussed.
A nurse is caring for a client who presents with a skin infection. While obtaining the patient's medical history, it is determined that the client is an intravenous drug abuser. To foster effective communication, the nurse should: a. consult with the social worker regarding inpatient drug rehabilitation. b. ask the client for a urine specimen for urine drug of abuse screening. c. remain honest, open, and frank. d. ask if the client realizes the infection is a direct result of the drug abuse.
c. remain honest, open, and frank Explanation: One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice. When a client feels that a nurse is being judgmental, he or she might withhold significant information. You need to develop sensitivity to the unique challenges presented by each client. A urine drug screen may eventually be ordered but is not necessary at this time. There is no evidence the client wants drug rehabilitation at this time. There is no evidence that the skin infection is secondary to the drug abuse.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. What is an example of the proper use of social media by a nurse? a. A nurse posts pictures of a patient who accomplished a goal of losing 100 pounds and later deletes the photo. b. A nurse describes a patient on Twitter by giving the room number rather than the name of the patient. c. A nurse describes a patient on Twitter by giving the patient's diagnosis rather than the patient's name. d. A nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's.
d. A nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's. Explanation: A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse as an individual and not the employer's. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or by accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly.
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: a. "Are you allergic to any medications?" b. "Can you tell me the medications you take on a daily basis?" c. "Do you have and advanced directive or living will?" d. "Can you tell me why your physician sent you here to be admitted?"
d. "Can you tell me why you physician sent you here to be admitted?" Explanation: When obtaining a nursing history, use the open-ended question technique to allow the client a wide range of possible responses. It allows the client to express what he or she understands to be true, yet is specific enough to prevent digressing from the issue at hand. It encourages free verbalization. The greatest advantage of this technique is that it prevents the client from giving a simple yes or no answer that has the effect of limiting the client's response. Eliciting medication use, allergies, or advanced directive determination are examples of closed communication where only one or a few words are required for an answer.
