N400 Nursing Concepts: Communication

An obese client is undergoing abdominal surgery. During the procedure a surgical resident states, "The amount of fat we have to cut through is disgusting." What is the best response by the nurse?

Inform the resident that all communication needs to remain professional.

Which communication technique is helpful in health teaching about relevant aspects of a client's well-being and self-care?

Informing

The nurse must use appropriate interviewing techniques to elicit accurate and complete health information. Which statement is an example of an open-ended question or comment?

"What brought you to the hospital this morning?"

A client admitted to the psychiatric unit for treatment of substance abuse tells a nurse, "It felt so wonderful to get high." What is an appropriate response?

"You told me you got fired from your last job for missing too many days after taking drugs all night."

The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.

-"How long have you experienced this pain?" -"Please point to where you are experiencing pain." -"Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." -"What aggravates your chest pain?"

The health care provider is in a hurry to leave the unit and tells the nurse to give morphine 2 mg IV every 4 hours as needed for pain. What action by the nurse is appropriate?

Inform the health care provider that a written order is needed.

A client has a cerebrovascular accident (CVA), resulting in flaccidity of the right side with aphasia. For this client, which intervention constitutes tertiary prevention?

Gait training and speech therapy

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action?

Give written instructions to the client and caregivers.

Which is the most common affective or mood disorder among older adults?

Depression

The nurse is preparing a client for surgery and asks if the client has an advance directive. The client asks "What is an advance directive?" What is the nurse's best response to this?

"An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so."

The health care provider has requested a urine sample from a female client for urinalysis. Which method should the nurse instruct the client to use to obtain a clean-catch urine?

"Begin to urinate while continuing to hold the labia apart. Allow the first urine to flow into the toilet."

The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what?

Provide the client with a feeling of responsibility and control over the client's behavior

A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication?

"Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you."

A nurse is using the SBAR approach for handoff communication when transferring a client to the critical care unit. Which statement would the nurse include as part of the recommendation?

"The client is scheduled for a cardiac catheterization in about an hour and needs monitoring every 15 minutes."

Which interaction is an example of social interaction, rather than a therapeutic professional nursing interaction, between a nurse and a client?

Equal sharing of time for discussion of problems so there is mutuality in the relationship

The nurse is conducting a community education program on stress. The nurse includes which information?

Excessive stress response increases susceptibility to illness.

During an interview for a position at an ambulatory clinic, the nurse notices that family planning counseling is included in the job description. As a devout Catholic, how should the nurse best proceed with the interview?

Excuse herself from the interview, stating she is Catholic

The nurse recognizes that both grading and staging are methods for classifying cancer and selecting a treatment plan. What is clinical staging used to determine?

Extent and spread of the disease

When asking an older adult client about abdominal pain, the client reports, "I don't want to be a bother because nothing hurts too much." The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action?

Gently mention that the client appears to be experiencing pain that can be treated.

A nurse is preparing to file a safety event report after a client experienced a fall. Which statement is correct regarding the filing of a safety event report?

The nurse should record the incident in the client's medical record and fill out a safety event report separately.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status?

The triggers in the environment

Which strategy would provide the most effective form of change of shift report?

Utilizing a reporting form and allowing time for any questions.

An older adult client who only speaks the nondominant language has been admitted to the emergency department after suffering a fall and suspected hip fracture in the home. Who is the best person to perform translation services for the client?

a hospital translator

Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse then makes a judgment and documents a statement summarizing those findings. This statement is called:

an evaluative statement

The nurse is preparing to provide details on a client to the healthcare team coming on duty for the next shift. Which form of communication should the nurse use to best enhance a safe transfer of care?

bedside report

A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:

characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing.

A nurse is preparing a health promotion program for teenagers focusing on lifestyle choices. Which of the following methods used by the nurse will best ensure the success of the program?

creating a safe environment for sharing information

A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse:

sits at the client's bedside and faces the client.

While responding to a client's call for help, the nurse finds the client lying on the floor. After assisting the client to bed and performing an assessment, the nurse informs the healthcare provider. In completing an incident report, the nurse documents that the client:

was found lying on the floor.

Which outcome for a client with a new colostomy is written correctly?

The client will demonstrate proper care of the stoma by 3/29/20.

The nurse managers of a home healthcare office wish to maximize nurses' freedom to characterize and record client conditions and situations in the nurses' own terms. Which documentation format is most likely to promote this goal?

narrative notes

A 35-year-old client with Down syndrome is on the nurse's unit following heart surgery. The client is very weak and has had difficulty with activities of daily living. Which statement is the best example of the nurse using advocacy as a style of client communication?

"I know that it has been difficult for you to walk to the bathroom to brush your teeth. How can we make this work for you?"

The client tells the nurse, "My mom is coming in to see me today," while sighing and looking out the window. The nurse states, "You don't seem very excited about the visit, is everything OK?" The client affirms. Using therapeutic communication, how should the nurse respond?

"I'm concerned that you are not excited about your mother's visit, We can talk if you want."

A client in a semiprivate room is diagnosed with pediculosis corporis. A nurse will initiate treatment after moving the client to another room. The client's roommate asks the nurse for information about the client. How should the nurse respond?

"I'm sorry, but I can't share confidential information."

Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which statement?

"It is best to stand when listening to a child to demonstrate knowledge." Correct: -"It is good to sit, not stand when listening." -"It is good to lean forward when listening." -"It is best to stoop to a child's level when listening."

The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed?

"We need to raise the volume of our voices significantly so he can hear us."

The physician asks the nurse not to disclose a client's diagnosis of end-stage cancer with the client until the client's family can be available to provide support. During the nurse's shift, the client asks the nurse, "What is wrong with me? Everyone is treating me like I am dying." Which of the following replies by the nurse allows the nurse to maintain integrity while providing care for the patient?

"You feel like people are treating you like you are dying?"

A nurse is assessing a client who has a rash on the chest and upper arms. Which questions would the nurse ask in order to gain further information about the client's rash? Select all that apply.

-"When did the rash start?" -"Are you allergic to any medications, foods, or pollen?" -"What have you been using to treat the rash?" -"Have you recently traveled outside the country?"

Which are appropriate actions for protecting clients' identities? Select all that apply.

-Document all personnel who have accessed a client's record. -Place light boxes for examining X-rays with the client's name in private areas. -Have conversations about clients in private places where they cannot be overheard.

The nurse knows that a framework that uses a language common to all aspects of nursing, regardless of the classification system, is desirable. In 2001, a taxonomy of nursing practice was developed and includes which of the following? Choose all that apply.

-NANDA -NIC -NOC

During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply.

-Reassure the client that they already covered these issues. -Review with the client the learned methods to control the problems.

A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.

-The nurse maintains eye contact with the client. -The nurse shows patience with the client and gives the client time to respond. -The nurse keeps communication simple and concrete.

A nurse is completing a health assessment with an adult client in a healthcare provider's office. What assessment findings will the nurse report to the healthcare provider as indications of fluid volume deficit? Select all that apply.

-increased heart rate -dry mucous membranes -muscle hyperreflexia

An older adult client presents at the emergency department (ED) with reports of fatigue and diarrhea. The client reveals areas of ecchymoses and burn marks. Which nursing actions are most appropriate? Select all that apply.

1. Provide explanations and support to the client. 2. Attend to the client's physical needs. 3. Report any signs of abuse to appropriate agencies.

When caring for woman who speaks a different language than one's own, the nurse must ask for an interpreter before having the client sign which forms to ensure clarity can be confirmed? Select all that apply.

1. surgical permit 2. end-of-life care 3. consent to blood transfusions

Which is an appropriately stated nursing intervention?

Ambulate 30 ft (9 m) twice a day with the assistance of a walker.

A client on long-term mechanical ventilation becomes very frustrated when he tries to communicate. Which intervention should the nurse perform to assist the client?

Ask the client to write, use a picture board, or spell words with an alphabet board

The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers?

Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality.

The nurse is caring for an 88-year-old male admitted 2 days ago for dehydration. The nurse brings the client his breakfast tray and notes that the client appears to be having difficulty understanding what she is saying to him today. Which nursing action is most appropriate?

Check the client's ear canals for cerumen.

A client is experiencing difficulty swallowing a large oral tablet. What action by the nurse would be most appropriate?

Check to determine whether the drug can be crushed or mixed with food.

The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which conflict resolution style does the nurse manager display?

Collaborating

Which is a skill appropriate to use in therapeutic communication?

Control the tone of the voice to avoid hidden messages.

The nurse is obtaining a health history from a client on an annual physical exam. Which documentation should be brought to the physician's attention?

Hoarseness for 2 weeks

The nurse is updating the records of a 10-year-old girl who had her appendix removed. Which action could jeopardize the privacy of the child's medical records?

Letting another nurse use the nurse's log-in session

The student nurse is caring for a 2 1/2-week-old in the newborn intensive care unit. Which term is most accurate when discussing this client?

Newborn

When recording data regarding the client's health record, the nurse mentions the analysis of the subjective and objective data, in addition to detailing the plan for care of the client. Which of the following styles of documentation is the nurse implementing?

SOAP charting

A client with a gastrointestinal disorder is having the number and quality of stool monitored by the nursing staff. The nurse notes an abnormal amount of fatty substances in the stool sample. Which term should the nurse use when documenting this assessment finding in the medical record?

Steatorrhea

A health care provider who just arrived on the unit gives a verbal order to the nurse regarding a nonemergent client situation. What is the nurse's appropriate response?

Tactfully request the provider to input the order into the computerized provider order system.

Which finding is an example of a variance in the critical pathway of a client 3 days after an above-the-knee amputation?

Temperature of 102° F (38.9°C)

The nurse is beginning the physical examination of a client with a complaint of fatigue. What documentation will the nurse provide to describe this general appraisal of the client's health?

The client appears mildly ill, listless, and disheveled.

The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action?

The client may have difficulty maintaining spacial boundaries.

The nurse has been asked to identify a location to conduct an interview with a psychiatric-mental health client. Which is an essential consideration when choosing a location?

The client's right to privacy

A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following?

The disease has entered the late stages.

A client has been diagnosed with PVD. On which area of the body should the nurse focus the assessment?

The lower extremities

The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?

Unresolved grief

A client diagnosed with prostate cancer is to receive brachytherapy. Which of the following would the nurse include when discussing this therapy with the client?

Use of radioactive seeds implanted into the prostate

The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response?

Validate the client's sense of impending loss and offer guidance for getting a wig.

The nurse is caring for a child whose mother is deaf and untrusting of staff. She frequently cries at the bedside, but refuses intervention from the social worker or the chaplain. Which issue is most important for the nurse to address with the mother to promote a trusting relationship?

communication barriers between the mother and staff

The nurse is documenting client information in the client's medical record. Which action by the nurse is appropriate when documenting information in a client's medical record?

ending each entry with a signature and title

A client has left-sided paralysis. The nurse should document this condition as left-sided

hemiplegia.

A client with newly diagnosed diabetes requests information about how to give an injection. What is the best communication technique the nurse can use with the client?

informing about the proper injection technique

The term metacommunication is best defined as:

interpersonal bridge between verbal and nonverbal communication.

Patient health education provided by the nurse

is an independent function of nursing practice.

A client is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which action is important for the nurse to tell the client to ensure accuracy in correlating dysrhythmias with symptoms?

It is important to keep a diary of activities and symptoms.

The nurse is performing discharge teaching for an elderly client with mild visual impairment. The nurse provides written instructions with large print and highlighted parts. The nurse also sits near the client, faces the client, and speaks in a lower-pitched voice. When the client arrives home, the client has difficulty following instructions. What error in teaching did the nurse commit?

Providing written instructions that are highlighted