PrepU ch. 8 communication
Which is a skill appropriate to use in therapeutic communication? a.Control the tone of the voice to avoid hidden messages. b.Avoid the use of periods of silence. c.Use cliches to enhance a client's understanding of information. d.Be precise and inflexible regarding the intent of the conversation.
a. Control the tone of the voice to avoid hidden messages. Conversation skills used in therapeutic communication include controlling the tone of one's voice so that exactly what is intended is conveyed and not any hidden message. Periods of silence have an important role in conversations because they allow for reflection. The nurse should avoid using cliches, and the conversation should be flexible.
A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be: a.aggressive. b.assertive. c.passive. d.nurturing.
a. aggressive. Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication.
Which nurse would most likely be the best communicator? a.An advanced practice nurse b.A nurse who easily develops a rapport with clients c.A nurse who is bilingual d.A nurse who is proficient in sign language
b. A nurse who easily develops a rapport with clients Rapport, a feeling of mutual trust experienced by people in a satisfactory relationship, facilitates open communication. Advanced practice does not make an individual an effective communicator. Although being bilingual or proficient in sign language allows a nurse to communicate with more people, it does not necessarily make the communication meaningful or effective.
When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is: a."It sounds as if your surgery is a pretty scary procedure." b."You have a great surgeon. You have nothing to worry about." c."You shouldn't be nervous. We perform this procedure every day." d."The thought of having surgery is keeping you awake."
d. "The thought of having surgery is keeping you awake." Reflection means repeating or paraphrasing the client's own statement back to the client to verify that the nurse understands what the client is saying. identifying the main emotional themes. Saying that the surgery sounds scary does not accurately reflect this client's statement. The other answers are offering false reassurance, which is not reflection nor therapeutic communication.
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should: a.ask the client for a urine specimen for urine drug use screening. b.consult with the social worker regarding inpatient drug rehabilitation. c.ask if the client realizes the infection is a direct result of the drug use. d.remain honest, open, and frank.
d. remain honest, open, and frank. 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, the client might withhold significant information. The nurse needs 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 use.
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication? a.Assess how the client would like to communicate b.Use facial and hand gestures c.Contact a person skilled in sign language d.Provide paper and pencil for written communication
a. Assess how the client would like to communicate Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge.
The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply. -"Are you ready to get out of bed?" -"What sorts of things do you do for fun?" -"What plans do you have after you are discharged?" -"Do you smoke cigarettes?" -"Is there any chance you might be pregnant?" -"Does it hurt when I touch you here?"
-"Are you ready to get out of bed?" -"Do you smoke cigarettes?" -"Is there any chance you might be pregnant?" -"Does it hurt when I touch you here?" The closed-ended question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed-ended questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. Closed-ended questions are often a barrier to effective communication. Asking what the client does for fun or what the client's future plans are facilitates communication between the client and the nurse.
A client has just been given a diagnosis of cirrhosis of the liver. Which statements by the nurse should be avoided because they could impede communication? Select all that apply. -"Cheer up. Tomorrow is another day." -"Your doctor knows best." -"That's a lot of information to take in. Would you like to talk about it?" -"Don't worry. You will be just fine in another day or two." -"Everything will be all right."
-"Cheer up. Tomorrow is another day." -"Your doctor knows best." -"Don't worry. You will be just fine in another day or two." -"Everything will be all right." A clichés© is a stereotyped, trite, or pat answer. Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Clients tend to interpret them as a lack of real interest in what they have said. For example, even though the common question "How are you?" could start a conversation, it can cause a problem if the client hearing this suspects that the nurse is not sincerely interested in how he feels. Statements such as: "Everything will be all right," "Don't worry," and "Cheer up" impede communication and foster false hope. Stating your doctor knows best can lead to powerlessness in the client. On the other hand, acknowledging that the client has just received a lot of information and that it is understandable if the client is struggling to process it all is empathetic, and offering to talk about it opens up a line of communication rather than closing it.
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 communicates in a busy environment to hold the client's attention. -The nurse keeps communication simple and concrete. -The nurse gives lengthy explanations of the care that will be given. -If there is no response, the nurse does not repeat what is said and takes a break.
-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. There are several nursing actions that would be appropriate to facilitate. The nurse would maintain eye contact with the client. The nurse shows patience and gives the client time to respond. The nurse keeps communication simple and concrete. The nurse would not communicate in a busy environment because this could be distracting to the client. The nurse would not give lengthy explanations to the client regarding the care to be given. The nurse would repeat the information if no response was shared by the client.
A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening? a."You seem unsure. Tell me your concerns about your surgery." b."I understand your confused, what do you think you should do?" c."I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?" d."You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure."
a. "You seem unsure. Tell me your concerns about your surgery." To understand the client's perspective, the nurse uses therapeutic communication techniques to encourage verbal expression. The use of active listening facilitates therapeutic interactions. "You seem unsure" demonstrates that the nurse was actively listening and has decoded the content and feelings of the client. "Tell me your concerns about your surgery" is an open-ended statement which will allow the client to express themselves. Giving clients the opportunity to be heard helps them organize their thoughts and evaluate their situation more realistically. "I understand you are confused" and "I understand that you are not sure" are examples of rescue feelings on behalf of the nurse. Saying I understand implies the nurse has the knowledge to fix the problem, especially followed by an explorative statement. Asking the client what he or she thinks he or she should do or why the surgery is not needed will put the nurse in the position to judge the response. "Please let me know if you decide to postpone the surgery until you are no longer unsure" suggests that the client should postpone the surgery and is an example of giving advice. The nurse should not give opinions, attempt to sway a client's opinion, or avoid an uncomfortable discussion.
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client? a.Approach the client with empathy and understanding and allow the client to share feelings without being judged. b.Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive. c.Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding. d.Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation.
a. Approach the client with empathy and understanding and allow the client to share feelings without being judged. Rapport is a feeling of mutual trust between nurse and client. Kindness is the quality of being friendly, generous, and considerate. Active listening and the use of silence are communication techniques, but they do not necessarily develop mutual trust between the nurse and client.
A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response? a.Be silent and allow the client to continue speaking when ready. b.Smile and say, "Don't worry, I am sure the physician is doing a good job." c.Nod and say, "I agree. If I were you, I would get a new doctor." d.Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
a. Be silent and allow the client to continue speaking when ready. When clients are angry or crying, the best nursing response is to remain nonjudgmental, allow them to express their emotions, and return later with a follow-up regarding their legitimate complaints. Therefore, staying silent and allowing the client to continue speaking when ready is the most appropriate response in this scenario. Giving false reassurance, agreeing, giving advice, or avoiding the subject are traps that block or hinder verbal communication.
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. What is a characteristic of empathy? a.Identifying with the client's feelings b.Experiencing feelings similar to those of the client c.Conveying genuine care to the client d.Caring for the client without negative judgment
a. Identifying with the client's feelings Empathy is the ability to identify with client feelings. 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 home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established? a.Orientation phase b.Working phase c.Termination phase d.Evaluation phase
a. Orientation phase During the orientation phase, the nurse discusses with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the nurse and client acknowledge that the agreement on which the relationship is based is concluding. There is no evaluation phase of the nurse-client relationship (evaluation is the final step in the nursing process).
The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important? a.Speak directly to the client. b.Ensure that family members are present. c.Give all of the discharge instructions at once. d.Have the interpreter write out all of the information listed in the unit brochure.
a. Speak directly to the client. When utilizing an interpreter, speak clearly in a conversational tone and directly address the client. While a client may be more comfortable having a family member present, this is not required. The nurse should not give all of the discharge instructions at once, which is likely to overwhelm the client, but provide discharge teaching in brief, manageable increments. Interpreters should not be asked to translate written information; instead, the nurse should verbally explain the brochure, or a copy should be obtained in the client's native language.
A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario? a.The working phase b.The introduction phase c.The orientation phase d.The termination phase
a. The working phase There are three phases of a helping relationship: the orientation phase, the working phase, and the termination phase. The introduction phase is not a valid phase, yet the nurse introduces oneself during the orientation phase. The scenario defines characteristics of the working phase, during which the nurse and client work together to meet the client's physical and psychosocial needs. During the orientation phase, the nurse and client establish the tone and guidelines for the relationship . The termination phase occurs when the nurse and client acknowledge that they have met the goals of the initial agreement or that the client would be better served by another nurse or health care provider.
A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult: a.an audiologist. b.an ophthalmologist. c.a clinical psychologist. d.an optometrist.
a. an audiologist. A nurse who suspects a speech, language, or hearing problem should refer the client to a speech-language pathologist or audiologist. A speech-language pathologist is a professional educated in the study of human communication, its development, and its disorders. An audiologist is a professional educated in the study of normal and impaired hearing. An ophthalmologist is a medical doctor who specializes in the treatment of eye disorders. An optometrist has a practice doctorate and focuses on vision. A clinical psychologist is a behavioral health expert.
A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should: a.sit at the bedside and allow the client to explain the statement. b.smile at the client and apologize. c.ignore the statement and empty the urinary catheter. d.inform the client that the unit was very busy that day.
a. sit at the bedside and allow the client to explain the statement. Clients may or may not feel able to speak freely to the nurse. Often, the signals indicating their readiness to talk are subtle. Don't miss valuable opportunities for important communication by approaching clients with a closed mind or focusing on your own needs rather than on the client's needs. Nurses who lack confidence in their own ability to meet the challenges a client presents might become defensive in response to a client's comments. Nurse defensiveness is a huge barrier to open and trusting communication. Smiling and apologizing and ignoring the client close lines of communication. Although the unit may have been busy, it is best to listen to the client express feelings.
The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client? a."This is so sad and I feel so bad that you are in this situation." b."It sounds as though you are most concerned about how your children will feel." c."I am so sorry that I am crying with you when you need my support the most." d."This just is not fair at all and I do not understand why this is happening to you."
b. "It sounds as though you are most concerned about how your children will feel." The nurse is demonstrating empathy when reiterating what the client is saying. This helps the nurse become effective at providing for the client's emotional needs while maintaining detachment. The other responses indicate that the nurse is feeling sympathy for the client, which includes feeling as emotionally distraught as the client. While this may be an unavoidable response, it may not help the client move through the grieving process as effectively.
The client is an 18-month-old in the pediatric intensive care unit. The client is scheduled to have a subgaleal shunt placed tomorrow, and the client's mother is quite nervous about the procedure. The nurse tells the client's mother, "The surgeon has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication? a.Rescue feelings b.False reassurance c.Giving advice d.Being moralistic
b. False reassurance False reassurance minimizes the client's concerns and feelings and is providing assurance not based on fact. Rescue feelings occur when a nurse feels a strong urge to personally try to fix the client or family member's problem. The nurse is not giving advice or being moralistic in this scenario.
When caring for a psychiatric client, a nurse would make a formal contract with the client during which phase of the nurse-client relationship? a.Intimate phase b.Orientation phase c.Working phase d.Termination phase
b. Orientation phase In the psychiatric setting, the orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are used as a therapeutic tool to help a client develop more insight and control over behavior. The working phase consists of the nurse and client working together to achieve the client goals established in the orientation phase. The termination phase consists of evaluating the client's progress toward meeting the goals and concluding the relationship. There is no intimate phase in the nurse-client relationship.
The nurse makes a contract with the client during which phase of the nurse-client relationship? a.Intimate phase b.Orientation phase c.Working phase d.Termination phase
b. Orientation phase The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase.
In the provision of care and the establishment of the therapeutic relationship, the nurse must first: a.understand the client's response. b.be aware of one's own personality. c.avoid labeling clients. d.treat the client with dignity.
b. be aware of one's own personality. Before a nurse can communicate therapeutically, a comfortable sense of self, such as being aware of one's own personality, values, cultural background, and style of communication, is necessary. The other answers represent important aspects of the therapeutic relationship but would occur after the nurse becomes aware of one's own personality.
A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because the nurse has not often performed wound care on a complex wound. Using effective intrapersonal communication, this nurse should: a.inform the client that several nurses will be needed to care for this wound. b.tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. c.tell the unlicensed assistive personnel (UAP) to gather supplies and to prepare to cleanse and dress the wound. d.ask the charge nurse to change the assignment.
b. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. Intrapersonal communication, or self-talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the client and family. Understanding the importance of intrapersonal communication can also help the nurse work with clients and families whose negative self-talk affects their health and self-care abilities. Speaking directly to the client, a UAP, or charge nurse is interpersonal communication, not intrapersonal. This duty cannot be delegated to an UAP. The nurse should not ask the charge nurse to change the assignment but could ask for help in dealing with the complex wound.
The child of a client who just died in a hospice unit arrives and asks, "May I please stay and sit at the bedside? I really wanted to be here so my dad would not die alone." Which statement made by the nurse best demonstrates the use of empathy? a."You are too late for that, but you may stay for a while if you would like." b."I tried to contact you earlier, but you did not answer your phone." c."I will close the door so you can spend some quiet time at the bedside." d."I understand. I lost my dad last year, and he died alone."
c. "I will close the door so you can spend some quiet time at the bedside." Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Empathy helps nurses become effective at providing for the client's needs while remaining compassionately detached. Sympathy, belittling, and defending are all nontherapeutic forms of communication.
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask: a."Do you check your blood pressure and pulse before you take your medication?" b."Have you tried exercising at all in the last week or two?" c."Were you tired and depressed before starting the new medication?" d."Tell me about the foods you are eating."
c. "Were you tired and depressed before starting the new medication?" Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence. The symptoms the client is complaining of are common adverse effects of this drug. Sequencing can determine the cause and effect in this scenario. Clients taking metoprolol should check their blood pressure and pulse before taking their medication. Asking about the current diet or exercise regimen does not uncover the cause and effect.
What nursing care behavior by the nurse engenders a client's trust in the nurse? a.A nurse tells the client, "Do not worry about the test, I have never cared for anyone that had problems with it." b.A nurse answers the client's questions about an upcoming test while completing documentation in the EHR. c.A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. d.A nurse tells the client, "My shift will be over in 45 minutes, I will let the oncoming nurse know you have questions about tomorrow's test."
c. A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. It is important to remember that helping relationships are professional relationships. Telling a client not to worry about the test because others have not had problems with it undermines trust by belittling the client's concerns. A nurse that answers the client's questions while documenting or defers the questions to the oncoming nurse gives the impression that the client's questions or concerns are not important. Answering the client's questions while making eye contact instils trust by showing that the nurse is competent to answer the questions and cares about the client in their care.
A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take? a.Allow the client's child to interpret. b.Involve a friend who speaks both the dominant and the client's languages. c.Contact a professional interpreter. d.Ask a fellow nurse who knows some words in the client's language to help.
c. Contact a professional interpreter. If an interpreter is necessary, the nurse should use a professional interpreter recommended by the facility or agency. It is inappropriate to rely on the client's family members or friends for this service. If the fellow nurse is not fluent in the language, then this nurse is not likely to be effective as an interpreter.
A nurse touches the client's hand while discussing the client's diagnosis. This action is: a.a dynamic process. b.a translation. c.a communication channel. d.an auditory channel.
c. a communication channel. A communication channel is a carrier of the message; touch can be a channel. Communication is a dynamic process, but simply touching one's hand is not. Touch is not translation--converting a message from one form to another--but is a channel for the message. Touch is a tactile, not auditory, channel.
Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice? a.empathy b.positive regard c.analysis d.comfortable sense of self
c. analysis Empathy, positive regard, and a comfortable sense of self were among the key ingredients. Empathy is an objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting yourself in another person's circumstances, and imagining what it would be like to share that person's feelings. Communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions or regard with the patient and family. Comfortable sense of self is part of the nursing confidence in caring for clients. Analysis is part of the nursing process and not the key elements of therapeutic communication.
A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation? a."Is your name Evelyn?" b."Are you in a hospital?" c."Is today the first day of the month?" d."What is your name?"
d. "What is your name?" Asking the client to state their name represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking closed-ended questions, which are answered with a simple yes or no response. The remaining responses are all closed-ended questions and therefore would not provide an accurate assessment of the client's orientation.
A nurse is discharging a client and thus terminating the nurse-client relationship. Which action should the nurse perform in this phase? a.Make formal introductions b.Create a contract regarding the relationship c.Provide assistance to achieve goals d.Examine goals of the relationship to determine whether they were achieved
d. Examine goals of the relationship to determine whether they were achieved In the termination phase, the nurse and client examine the goals of the nurse-client relationship for indications of their attainment or evidence of progress toward them. If goals were not attained, the nurse should help the client establish a relationship with a new nurse. Making formal introductions and making a contract regarding the relationship occur in the orientation phase. Providing assistance to achieve goals occurs in the working phase.
An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is nervous about the surgery. The best response by the nurse is to: a.look directly at the client and state, "You are nervous about the surgery." b.ask the surgeon to come to the bedside to reassure the client. c.state "Everyone is nervous before surgery." d.ask the client "Can you tell me more about what is worrying you?"
d. ask the client "Can you tell me more about what is worrying you?" Asking what is worrying the client opens the lines of communication. Making a sweeping generalization that does not necessarily apply to a specific client hinders communication and makes the person feel insignificant. Restating the client's concern is inappropriate at this time. The nurse should not ask the surgeon to reassure the client.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: a.ask the client's partner to leave the room to allow the client to focus. b.ask all visitors to leave the room. c.ask the client if she is able to read. d.eliminate as many distractions as possible.
d. eliminate as many distractions as possible. Factors that distort the quality of a message can interfere with communication at any point in the process. These distractors might be from the television, or from pain or discomfort experienced by the client. Visitors may remain in the room as long as the mother agrees and they do not interfere with the education session. It may also be beneficial for others to learn the care in the event that they too will be caregivers for the infant. For this reason, it is best for the client's partner to remain in the room.
