PrepU chapter 8: Communication

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 nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's

A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question?

"I understand you have four kids, how many times have you actually been pregnant?"

A pregnant client is seeking information from the nurse about a home birth with registered midwives. Which of the following statements lets the nurse know that the client has considered the risks and benefits of using a midwife? Select all that apply.

"I will develop a list of questions to use in interviewing potential midwives." • "I understand the complications that could occur in a home birth setting." • "I realize that I may need to be transferred to a hospital if complications develop."

A client in a semiprivate room is diagnosed with pediculosis corpus. A nurse will initiate treatment after moving the client to another room. The client's hintroommate!hint asks the nurse for information about the client. What should the nurse say?

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

You have been notified that a patient is being admitted from emergency with abdominal pain. The patient will be admitted by wheelchair to the unit for observation. You delegate the preparation of the room to the unlicensed worker with these instructions:

'Bring all equipment for vital signs to the patient's room. • Place an admission pack in the room. • Prepare an open the bed in the low position Preparing the room for admission may be delegated by the nurse. The bed should be placed for easiest access: low if the patient is ambulatory/can stand, and high if being transferred from a stretcher. Room preparation includes assembling all needed equipment and patient supplies. It remains the nurse's responsibility to determine that all preparations are completed. (

A client has just been given a diagnosis of cirrhosis of the liver. Which of the following statements by the nurse should be avoided because they could impede communication? Select all that apply.

-Everything will be all right -Cheer up. Tomorrow is another day.? -Don?t worry. You will be just fine in another day or two.? -Your doctor knows best.?

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

.) The nurse maintains eye contact with the patient. • The nurse is patient and gives the patient time to respond. • The nurse keeps communication simple and concrete.

A bedridden client is scheduled to receive subcutaneous injections of heparin at 8:00 a.m. and 8:00 p.m. each day. The client's medication administration record would present these times as:

0800 and 2000

A nurse is working with the Red Cross to assist a family whose home was destroyed by fire. Which statement is most appropriate to assist with this situational crisis?

? You have had a tremendous loss. What are your plans for shelter tonight??

Which documentation tool will the nurse use to record the patient's vital signs every 4 hours?

A graphic sheet

A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying:

Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them."

A client has been diagnosed with colon cancer with metastasis to the lymph nodes. When the nurse enters the room, the client says life is "not worth living." What is the nurse's best therapeutic response?

Approach the client and ask if there are questions about the condition

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique is most helpful?

Ask the child to draw a picture

A 9-year-old child is scheduled for an electromyelogram. To prepare the child for this procedure, what should the nurse do first?

Ask the child to draw a picture of the body structures involved.

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

Ask the client to write or spell words with an alphabet board.

A client undergoes cystoscopy with bladder biopsy. After the procedure, which assessment is most appropriate for the nurse to make?

Assess urine for excessive bleeding After cystoscopy with biopsy, the nurse would assess for excessive hematuria, which might indicate hemorrhage caused by the biopsy. Catheters are not routinely inserted after cystoscopy. The nurse would not assess for bladder distention unless the client was having difficulty voiding. Urine cultures are not routinely ordered after cystoscopy

A client undergoes cystoscopy with bladder biopsy. After the procedure, which assessment is most appropriate for the nurse to make?

Assess urine for excessive bleeding.

Which of the following nursing interventions is an example of tertiary preventative care?

Assisting with speech therapy for a patient with a traumatic brain injury

The nurse manager is holding a meeting with the nursing team to discuss management's decision to reduce staffing on the nursing unit. During the discussion, one of the staff nurses stands up and yells at the nurse manager, using profanity, and threatening "to take this decision further." To defuse this situation, which of the following would be the best step for the nurse manager to take?

Call a break in the meeting and talk to the nurse in a private place.

A nurse was informed that a family member was involved in a car accident and transported to the emergency department in the same facility. What action by the nurse best demonstrates understanding of client privacy?

Calling the client information desk to find out the room number of the family member

The nurse is educating the client about management of diabetes. An inappropriate statement by the nurse is

Checks of blood glucose level are to be done ac and hs When providing education, the nurse is to give clear information and avoid the use of medical terminology or "jargon" as in ac and hs.

A nurse administering medications accidentally gives a double dose of blood pressure medications. After ensuring the safety of the client, the nurse would document the error in which documents?

Client's record and occurrence report

Communication is very important when preparing a client for a mastectomy. What are primary issues for the nurse to discuss?

Concerns regarding the cancer and how the surgery will affect the client

A nurse faxes a client's medical record to the wrong physician's fax machine. Which of the following should be the immediate action by the nurse?

Contact the physician, ask that it be shredded, and complete an incident report.

The nurse is caring for a client after surgery. The surgeon has written "resume pre-op meds" as an order on a client's chart. What should the nurse do next?

Contact the surgeon for clarification because this is not a complete order.

While performing passive range-of-motion exercises on the lower extremities of a patient with a spinal cord injury, the nurse assesses permanent flexion of the muscles. What term will the nurse use to document this finding related to the muscles?

Contractures

Nursing documentation is inclusive. Which is the best example of documentation of a teaching plan?

Cord care shown to mother, questions answered. Return demonstration observed.

The nurse is providing care for a 69-year-old male patient who has been admitted to the hospital for the treatment of pneumonia. Auscultation of the patient's lungs reveals the presence of discontinuous, popping sounds during inspiration over the lower lung fields. Which of the following should the nurse document the presence of?

Crackles

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

The client, who is 8 weeks pregnant as the result of a rape, tells the nurse, "I do not want to have this baby, but I have always believed that abortion is a sin. I don't know what to do." What nursing diagnosis would be most appropriate for the nurse to formulate?

Decisional conflict related to conflict with moral beliefs as evidenced by the client's statement

The nurse is caring for a hospitalized 90-year-old client. Which of the following will the nurse include in the care plan?

Decreasing environmental noise

Which is the most common affect or mood disorder of the older adult?

Depression

The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care?

Develop an alternate method of communication.

A nurse administers digoxin 0.125 mg to a client at 1400 instead of the prescribed dose of digoxin 0.25 mg. Which of the following statements should the nurse record in the medical record?

Digoxin 0.125 mg given at 1400 instead of prescribed dose of 0.25 mg

In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant?

Dispose of the disconnected IV set

The nurse is caring for an adolescent with cancer who is well informed about the medical condition and treatment. The adolescent refused the morning medications and states intentions of refusing all future medications. What is the best action by the nurse?

Document the adolescent's choice and offer to discuss feelings about the medication.

A client has been prescribed a narcotic analgesic to be given around the clock for cancer-related pain. The client is competent and has actively been involved in decisions regarding care. What should the nurse do when the client refuses the next dose of pain medication?

Document the client's choice and reassess the pain in 1 hour.

A patient diagnosed with a stroke is having difficulty forming words during communication. This would be appropriately documented as which of the following?

Dysarthria

Which of the following would be included in the teaching plan for a patient diagnosed with diabetes mellitus?

Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.

A family member tells the nurse that they resent that the client is using their pain to manipulate family members into driving the client everywhere versus the client driving themselves. What is the appropriate action by the nurse?

Encourage an honest discussion of the problem with the client.

Which of the following 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

A nurse is caring for a client who has a large, hardened mass of stool interfering with defecation, making it impossible for the client to pass feces voluntarily. How should the nurse document this condition?

Fecal impaction

The circulating nurse is documenting all medications administered during a surgical procedure. The anesthesiologist administers an opioid analgesic. What medication would the nurse check as having being administered?

Fentanyl (Sublimaze)

A patient has been diagnosed as having global aphasia. The nurse recognizes that the patient will be unable to do which of the following actions?

Form words that are understandable or comprehend the spoken word

Which lobe of the brain is responsible for concentration and abstract thought?

Frontal

Which question would help the nurse gather information about a client's lifestyle that may be a factor in the client's present illness?

How many cups of coffee do you drink each day

The client who has a history of angry outbursts when frustrated begins to curse at the nurse during an appointment after being informed that she will have to wait to have her medication refilled. Which response by the nurse is most appropriate?

I will not continue to talk with you if you curse."

A nurse is assisting a client with his bed bath. The client states, "I can do it myself." The nurse's best response is

I will set up your bath for you. I will come back and help you with your back."

A nurse on a night shift entered an elderly client's room during a scheduled check and discovered the client on the floor beside her bed after falling when trying to ambulate to the washroom. After assessing and assisting the client back to bed, the nurse has completed an incident report. What is the primary purpose of this particular type of documentation?

Identifying risks and ensuring future safety for clients.

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. Which of the following symptoms would she include when reviewing classic symptoms associated with diabetes?

Increased thirst, increased hunger, and increased urination

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

Informing

A nurse identifies a nursing diagnosis of "Anxiety related to hospitalization and uncertainity about diagnostic test results." Which of the following actions by the nurse will be an attempt to decrease client anxiety?

Maintaining eye contact and carefully listening to client responses and concerns

A patient seen in the outpatient clinic has common variable immunodeficiency. It is important for the nurse to teach the patient about the need for more frequent screening for which of the following complications?

Malignancy

Mr. Fields is a resident of a long-term care facility who has moderate hearing loss. When communicating with Mr. Fields, what should the nurse do?

Minimize background noises and ensure that lighting is adequate to see the nurse's face.

The nurse is caring for a 48-year-old male patient with a new colostomy. Which patient goal for Mr. Conner is written correctly?

Mr. Conner will demonstrate proper care of stoma by 3/29/15.

A nurse is conducting an assessment of a client. Which client statement would indicate to the nurse that the client has a nonmodifiable risk factor for mental health problems?

My father was diagnosed with depression in his 40s

The nurse is assessing a client for changes in health condition. After listening to the client's lungs for adventitious breath sounds, the nurse also checks the client's latest white blood count (WBC) lab value. The nurse is gathering which type of data when looking up the lab value?

Objective

When assessing for pain in a toddler, which method should be the most appropriate?

Observe the child for restlessness.

A comprehensive definition of family is that it is a social group with members who share common values, interact over time, and

Occupy specific positions

Which nursing action helps to maintain a sense of self for clients?

Offering a simple explanation before initiating any procedure

The nursing instructor is discussing communication with a student. The student identifies that a contract is made with the client during which phase of the nurse-client relationship?

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 used as a therapeutic tool to help a client develop more insight and control over his or her own behavior.

What is the rationale for health care personnel to orient clients to rooms and equipment when they are admitted to the hospital?

Orienting clients to the surroundings decreases the potential for injury.

A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people?

People-first

primary prevention:

Primary prevention initiatives work to prevent risk factors for disease through patient education initiatives.

A nurse is maintaining a problem-oriented medical record for a client. Which of the following components of the record describes the client's responses to what has been done and revisions to the initial plan?

Progress notes

Receptive aphasia

Receptive aphasia, also known as Wernicke's aphasia, fluent aphasia, or sensory aphasia, is a type of aphasia in which an individual is unable to understand language in its written or spoken form.

The sharing of information about a client is

Reporting

The nurse employs interpersonal skills of communication when caring for and interacting with patients. Which of the following is the best example of establishing a therapeutic nurse-patient relationship?

Respect for the patient and open communication to engage in getting to know the patient.

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 nursing implementing?

SOAP charting

Which statement about the initial care of a suspected abuse victim, when documented on the chart, would be most helpful for others when caring for the client?

Seems fearful to discuss how bruises on her body had been caused."

A nurse is assessing a client and attempting to differentiate if the client is experiencing grief or depression. Which of the following would the nurse identify as indicative of grief?

Self-blame

An adolescent states, "I want to go to college and learn to be a chef." This is an example of

Self-expectation

What are important nursing responsibilities when a referral to other health team members has been made for a client?

Sharing assessment information and information on the client's capability and level of participation in meeting activities of daily living

The mother of a client with schizophrenia calls the visiting nurse in the outpatient clinic to report that her daughter has not answered the phone in 10 days. "She was doing so well for months. I do not know what is wrong. I am worried." Which response by the nurse is most appropriate?

She may have stopped taking her medications. I will check on her.

The nursing instructor is teaching the students how to do an interview on a client. Which of the following statements made by a student indicates a need for further instruction?

Show your name badge to the client so they can read who you are

The nurse is assessing the communication style of the client. Which dimension of the individual is communication an example of?

Sociocultural dimension

One of the patients you are caring for today is Jeff, a 13-year-old boy who has suffered a concussion while playing hockey. Your morning assessment finds him very drowsy but he responds normally to stimuli. You document his level of consciousness as which of the following?

Somnolence

A client, who was hospitalized after a fall sustained while intoxicated, experienced alcohol withdrawal delirium during the hospitalization. A few days after the client's sensorium clears, the client tells the nurse that drinking helps to cope with anxiety related to a recent divorce. Which response by the nurse would help the client view the drinking more objectively?

Tell me about the last time you were under a lot of stress and drinking to cope."

A client tells a nurse that he drinks heavily in the evenings and would like to stop. The nurse suggests that he attend Alcoholics Anonymous, but he says, "I went to one men's meeting and all they did was swear and brag about how drunk they got." Which response would be best for the nurse to make?

The Alcoholics Anonymous meetings vary from group to group. Have you thought about attending another group

The nurse considers which client aspect as nonverbal communication?

The client's tone of voice

The Joint Commission encourages patients to become active, involved, and informed participants on the health care team. What nursing action follows JC recommendations for improving patient safety by encouraging patients to speak up?

The nurse encourages the patient to participate in all treatment decisions as the center of the health care team.

A nurse is providing teaching to patients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? (Select all that apply.)

The nurse fails to accept that patients have the right to change their minds. • The nurse uses medical jargon frequently when discussing the teaching plan. • The nurse ignores the restrictions of the patient's environment.

The nurse has selected a nursing diagnosis of "Impaired home maintenance" for an elderly client. What assessment data would evidence this diagnosis?

The nurse observes unsafe conditions in the client's home. The observation of unsafe conditions indicates that the client is not effectively maintaining the home. The client's confusion may be a temporary condition and does not take into account any help the client has in maintaining the home. Living with family members provides a source of support for the client which should assist in home maintenance. The client's distaste for housework does not mean that the client is not maintaining the home

A client scheduled for a total laryngectomy and radical neck dissection begins talking rapidly, commenting, "I'm really nervous and scared about the operation." What is the most therapeutic action by the nurse?

The nurse should listen attentively and provide realistic verbal reassurance.

A postoperative client states "I don't understand why you are checking my skin on my back -- my surgery was on my stomach." What is the nurse's best response?

The operating table is a firm surface; we need to be sure your skin looks okay

In order to provide effective nursing care, the nurse should engage in what type of communication with the patient and significant others?

Therapeutic communication

A nurse enters the client's room and finds the client lying on the floor experiencing a seizure activity. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report?

To evaluate quality care and potential risks for injury to the client

A nurse is preparing to interview a client as part of the assessment. The nurse demonstrates knowledge of communication skills when the nurse does which of the following?

Uses broad, open statements

A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which of the following statements?

We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen (HLA)-identical sibling."

The nurse is providing information about strokes to a community group. Which of the following would the nurse identify as the primary initial symptoms of an ischemic stroke?

Weakness on one side of the body and difficulty with speech

A client has identified to the community mental health nurse that an inability to be assertive with the client's boss has contributed to long work hours and increased stress and anxiety. To assist the client, which of the following questions would be most appropriate for the nurse to ask?

What have you done so far to try to solve this problem?"

The parent of a hospitalized toddler tells the nurse, ?If my child uses the word ?toytoy' a bathroom trip is needed.? What action by the nurse best communicates this information about basic care needs for the client?

Writing the information in the plan of care

A patient who is taking Tylenol for a fever asks a nurse if there is a generic form that is less expensive. What would the nurse tell him?

Yes, and it is acetaminophen

While providing palliative care to a client in the home setting, the client's family expresses concern that the client is receiving "too much narcotic medication." Which of the following statements is the most therapeutic response by the nurse?

You are concerned that the client is receiving too much narcotic medication?"

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." Confronting the client with the consequences of substance abuse helps break through his denial.

A physician orders ampicillin, 500 mg by mouth every 6 hours. This medication order is an example of:

a standing order.

Dysarthria

difficult or unclear articulation of speech that is otherwise linguistically normal.

Dysphagia

difficulty swallowing

The client diagnosed with borderline personality disorder who is to be discharged soon threatens to "do something" to herself if discharged. The nurse should first:

discuss the meaning of the client's statement with her.

diplopia

double vision

When the nurse recognizes that he has documented one client's assessment data on the wrong client's medical record, the nurse should

draw a single line through the error, initial it, and write the correct entry

A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to:

have group members confront the dominant member to promote the needed team work.

While assessing a client diagnosed with dementia, the nurse notes that her husband is concerned about what he should do when she uses vulgar language with him. The nurse should:

ignore the vulgarity and distract her

secondary prevention:

initiatives work to identify and detect disease in its earliest stages, when it is most likely to be treated successfully

Tertiary prevention

involve an actual treatment for the disease.

You are assigned to care for a patient who will be transferred to the rehabilitation unit in the hospital following his postoperative recovery from hip surgery. The priority nursing responsibility when transferring a patient from one unit in the hospital to another is to:

provide a verbal report of the patient's status to the admitting nurse.

When preparing to transfer your elderly patient back to the long-term-care facility where he has been for several years, it is the primary responsibility of the nurse to:

provide for the coordination and continuity of care by the healthcare providers.

When communicating with a client who has sensory (receptive) aphasia, the nurse should:

use short, simple sentences. Although sensory aphasia allows the client to hear words, it impairs the ability to comprehend their meaning. The nurse should use short, simple sentences to promote comprehension. Allowing time for the client to respond might be helpful but is less important than simplifying the communication. Because the client's hearing isn't affected, speaking loudly isn't necessary. A writing pad is helpful for clients with expressive, not receptive, aphasia

A client is being transferred from the recovery room to the medical surgical nursing unit. The nurse from the recovery room should report which information to the nurse in the medical surgical unit? Select all that apply.

• type of surgery • current vital signs • amount of blood loss • fluids infusing including rate and type of fluid