Theory Communication
A nurse is teaching a client how to use the call bell/call light system. Which level of Maslow's hierarchy of needs does this nursing action address? Safety Self-esteem Physiological Interpersonal
A call bell system enables the client to communicate with the staff and supports safety and security, which is a second-level need. Self-esteem involves intrapersonal needs, the fourth level of basic needs. Physiological needs include air, food, and water and represent the first level of needs. Interpersonal needs involve love and belonging, which are third-level needs.
A 2.5-year-old child is admitted for treatment of injuries supposedly sustained in a fall down a flight of stairs. Child abuse is suspected. What statements might the nurse expect from a parent who engages in child abuse? Select all that apply. "Kids have to learn to be careful on the stairs." "Every time I turn around the kid is falling over something." "This child tends to be adventurous and doesn't understand about getting hurt on the stairs." "I can't understand it. This child didn't have a problem using the stairs without my help before this." "I try to keep an eye on my child, but little kids are always on the go and I just can't keep running after the kid."
Abusive parents often have a poor understanding of the expected growth and development of children and tend to blame the child. Toddlers generally need supervision and some assistance when climbing stairs, but abusive parents have little understanding of toddlers' abilities. Although "Kids have to learn to be careful on the stairs" is a true statement about toddlers, it is an unlikely response from an abusive parent because these people do not have an understanding of children's needs in relation to growth and development. "This child tends to be adventurous and doesn't understand about getting hurt on the stairs" is an unlikely response from an abusive parent because these people do not have an understanding of children's needs in relation to growth and development. Although "I try to keep an eye on my child, but little kids are always on the go and I just can't keep running after the kid" is a true statement about toddlers, it is an unlikely response from an abusive parent because these people usually do not have an understanding of children's needs in relation to growth and development.
What should the nurse do when a client with the diagnosis of schizophrenia talks about being controlled by others? Express disbelief about the client's delusion. Divert the client's attention to unit activities. React to the feeling tone of the client's delusion. Respond to the verbal content of the client's delusion.
Reacting to the feeling tone of the client's delusion helps the client explore underlying feelings and allows the client to see the message that the verbalizations are communicating. Expressing disbelief about the client's delusion denies the client's feelings rather than accepting and working with them. Attempting to divert the client rather than accepting and working with the client denies the client's feelings. Responding to the verbal content of the client's delusion focuses on the delusion itself rather than on the feeling that is causing the delusion.
A young client with schizophrenia says, "I'm starting to hear voices." What is the nurse's most therapeutic response? "How do you feel about the voices, and what do they mean to you?" "You're the only one hearing the voices. Are you sure you hear them?" "The health team members will observe your behavior. We won't leave you alone." "I understand that you're hearing voices talking to you and that the voices are very real to you. What are the voices saying to you?"
"I understand that you're hearing voices talking to you and that the voices are very real to you. What are the voices saying to you? Acknowledging that client is hearing voices and that the voices are very real to the client validates the presence of the client's hallucinations without agreeing with them, which communicates acceptance and can form a foundation for trust; it may help the client return to reality. The nurse also needs to assess the content of the voices to determine the risk of self-injury or violence against others. The client's contact with reality is too tenuous to explore what the voices mean. Saying that the client is the only one hearing the voices and asking whether the client is sure the voices are being heard demeans the client, which blocks the development of a trusting relationship and future communication. Telling the client that the health team members will observe the behavior and that the client won't be left alone is condescending and may impair future communication
A school-aged child is brought to the clinic by the mother, who states, "Something is very wrong. My child never seems happy and refuses to play." When assessing this child for depressed behavior, what statement should the nurse initially begin with? "Tell me about yourself." "Let's talk about what you do after school." "Can you tell me what's making you so unhappy?" "Why does your mother think that you're unhappy?"
"Let's talk about what you do after school." A structured but nonthreatening question such as asking what the child does after school avoids beginning with the problem and may put the child at some ease, producing information that may be useful. The statement "Tell me about yourself" is too open and global; the child will probably not know how to answer this question or know where to begin. The child may not know the answer to the question "Can you tell me what's making you so unhappy?" Asking "Why does your mother think that you're unhappy?" will probably produce an "I don't know" response; the focus should be on the child, not the mother.
A client with schizophrenia reports having ongoing auditory hallucinations and describes them as "voices telling me that I'm a bad person" to the nurse. What is the best response by the nurse? "Try to ignore the voices." "What are the voices saying to you?" "Do you believe what the voices are saying?" "They're only voices, so just try not to be afraid."
"Try to ignore the voices." Clients can sometimes learn to push auditory hallucinations aside, particularly within the framework of a trusting relationship; it may provide the client with a sense of power to manage the voices. Once it has been established by the nurse that the voices are not commanding the client to self-harm or harm others, focusing on the content of the hallucinations is not therapeutic. Asking whether the client believes what the voices are saying or encouraging the client not to be afraid of them is irrelevant to the situation; clients believe in and are frightened by hallucinations.
A client with schizophrenia who has auditory hallucinations is withdrawn and apathetic. What should the nurse say to involve this client in an activity? "You'll get a reward if you go to the gym." "Would you like to participate in the group walk today?" "Those voices you hear would like it if you did a little exercise." "There's a positive relationship between exercise and good mental health."
"Would you like to participate in the group walk today?" is a declarative statement that invites the client to walk, and the client can comply without making a verbal decision. A client with schizophrenia is often ambivalent, rendering decision-making difficult. A withdrawn, apathetic client probably will not internalize or appreciate rationales for interventions. Saying that the voices want the client to exercise supports the client's hallucinations
A disturbed client says, "The voices are saying that I killed my husband." What is the best response by the nurse? "I just saw your husband, and he's doing fine." "Tell me more about your concerns for your husband." "We'll put you in a private room where you'll be safe." "You seem to be having very frightening thoughts right now."
"You seem to be having very frightening thoughts right now" demonstrates that the nurse understands the client's feelings; reflection opens a channel for communication. The nurse cannot talk the client out of her delusions by pointing out reality. Focusing on delusional content only reinforces false beliefs. "We'll put you in a private room where you'll be safe" does not reflect the content of the client's statement.
While receiving a preoperative enema, a client starts to cry and says, "I'm sorry you have to do this messy thing for me." What is the nurse's best response? "I don't mind it." "You seem upset." "This is part of my job." "Nurses get used to this."
"You seem upset." The nurse should identify clues to a client's anxiety and encourage verbalization of feelings. Saying it is part of the job focuses on the task rather than on the client's feelings. Saying "I don't mind it" or "Nurses get used to this" negates the client's feelings and presents a negative connotation.
A client is placed on a restricted diet. What is the best communication technique for the nurse to use when beginning to teach the client about the diet? Asking about what type of foods the client usually eats Telling the client that the diet must be followed exactly as written Telling the client that the intake of foods on the list must be limited Asking about what the client knows about the diet that was prescribed
Asking about what the client knows about the prescribed diet may validate the client's understanding; the response may indicate the need for further teaching or that the client understands; understanding and accepting the need for restrictions will increase adherence to the diet. Assessing the client's food preferences and teaching about diets follow an assessment of the client's understanding about the need for a specific diet; the client must understand the need for and the benefits of the diet before there is a readiness for learning. Telling the client that the diet must be followed exactly as written and telling the client that the intake of foods on the list must be limited are authoritarian and should be avoided.
A client who has participated in caring for her infant in the neonatal intensive care unit for several days in preparation for the infant's discharge comes to the unit on the last hospital day with an alcohol odor on her breath and slurred speech. What is the most appropriate action for the nurse to take at this juncture? Speak with the mother about her condition and assess her willingness to participate in an alternate discharge plan. Request that the mother wait in the hospital lobby and call the primary healthcare provider to cancel the discharge order. Speak to the mother about her condition and have her see a social worker about the infant's discharge to a foster home. Continue with the discharge procedure and alert the home health nurse that the mother needs an immediate follow-up visit.
Confrontation regarding the active substance abuse and the mother's diminished ability to care for the infant safely at this time is necessary to help the mother obtain help and to protect the infant. Decisions should not be made without input from the mother. Continuing with the discharge procedure and alerting the home health nurse that the mother needs an immediate follow-up visit is unsafe; the mother may not be capable of caring for the infant.
A newly immigrated older Chinese adult is brought to a mental health clinic when family members become concerned that their parent is depressed. In an attempt to conduct a culturally competent assessment interview, the nurse asks certain questions. Which questions does the nurse ask? Select all that apply. "What brought you here for treatment today?" "What do you believe is the cause of your depression?" "Does religion have a role in your perception of health and wellness?" "Do you have insurance that includes coverage of mental health issues?" "Have you ever sought treatment for a mental health problem previously?"
Determining the client's perception of the problem is an appropriate question that allows cultural factors to be included. Encouraging the client to discuss the problems will facilitate a clearer understanding of the factors involved. Religion often plays a significant role in a client's view of health, wellness, and recovery. Knowing whether a client has ever undergone treatment for a mental health problem reveals mental health history and how previous issues were addressed. Insurance coverage is not pertinent to the issue and is an inappropriate topic of questioning by the nurse.
The parent of a 4-year-old client states, "My child gets so upset when I ask her to stop talking so that I can answer a work phone call. I don't understand why this happens." Which response by the nurse is most appropriate? "School is a source of stress for many children at this age." "Worrying is a source of stress for many children at this age." "Attention is a source of stress for many children at this age." "Belongings are a source of stress for many children at this age."
Lack of attention is often a stressor for the 4-year-old preschool-age client; therefore, the nurse should provide education about this stressor to the parent. The child's reaction is not due to the stressors of school, worrying, or belongings
Which activity of the registered nurse is included in supervision? Performing the given task Allocating a portion of the work Providing information to the delegator Providing guidance and oversight in delegating a task
Supervision is defined as "provision of guidance and oversight of a delegated nursing task." It includes open lines of communication between the delegator and the delegatee to provide guidance. Responsibility is the activity of performing a given task. Delegation is the activity of allocating a portion of work. Authority is the activity of providing information to the delegator.
A reasonable short-term outcome for clients who are functioning below the optimal level of mental health is to help them become better able to do what? Understand the dynamics behind their inadequate interpersonal relations. Confront their inadequacies in interpersonal relations and be more sociable. Discuss feelings regarding their life experiences and their significant others. Take actions that will increase their satisfaction with their relationships with others.
The ability to discuss feelings about others and life situations is necessary for positive mental health. Understanding interpersonal dynamics, confronting inadequacies, and taking actions to increase satisfaction in relationships are all long-term, not short-term, outcomes.
A 16-year-old girl has been admitted to the pediatric eating disorders unit with a diagnosis of anorexia and is undergoing behavioral therapy. Unit privileges are based on weight gain and have been explained to the client. What is the most appropriate intervention for the nurse to use when taking the lunch tray to the client's room? Setting the tray down and saying nothing Reminding the client that eating will be rewarded Commenting on the client's thinness and need to gain weight Threatening the client that if she doesn't eat she won't gain any privileges
The client uses eating/weight gain as a means of controlling the environment. The client has been told the rules of the unit and must make the personal decision to try to win privileges. The nurse needs to take the focus away from eating. The client knows that gaining weight will be rewarded and does not need reminders. The client is used to everyone commenting on her weight. Although the client appears thin to others, the client's self-perception is that she needs to lose a little bit of weight. Threats should not be used in any circumstance.
The parents of a 6-year-old boy tell the nurse in the pediatric clinic that their son has recently started to wet the bed at night. What is the most helpful response by the nurse? "How's your son doing in school?" "Have there been any changes in his life recently?" "You should arrange to see the doctor, because there may be a physical problem." "When children are angry at their parents, they may use bed-wetting to punish them."
The collection of more information is essential before the nurse can intervene further. Asking a general question opens the lines of communication. Asking specifically about school might be appropriate later in the discussion. Suggesting a medical consultation is premature; more information is needed. Enuresis is usually not a behavioral response precipitated by anger; this statement may cause the parents to feel guilty or become defensive.
After a week on the mental health unit, a client with the diagnosis of paranoid schizophrenia continues to say, "They're trying to kill me. They all are." What is the best response by the nurse? "We're here to protect you." "No one wants to hurt anyone." "You're having very frightening thoughts." "Tell me more about their wanting to kill you."
The observation that the client is experiencing frightening thoughts is a reflection of the client's feelings; it leaves the line of communication open. Telling the client that the staff is there to protect the client does not provide security, because the client may believe that the nurse is one of the people plotting. Telling the client that no one wants to hurt anyone discounts the client's thoughts and may increase the agitation. Asking the client to detail the plot supports the client's delusion.
The nurse leader is giving a speech on leadership skills to followers. Which questions enable the nurse leader to evaluate the understanding level of the followers? Select all that apply. "Are you getting my points?" "Would you all like a break?" "Can I change the topic in a little while?" "How can you solve a conflict at the workplace?" "What did you 'hear' in the process of this communication?"
The question such as "what did you 'hear' in the process of this communication?" cannot be answered by a "yes" or "no" and requires a detailed explanation of the things that are taught. The questions starting with "how" are usually open-ended and require the person to answer in detail. Therefore these questions can help the nurse leader evaluate the understanding level of the followers. The questions such as "are you getting my points?", "would you all like a break?", and "can I change the topic in a little while?" can be answered by a "yes" and "no." Therefore these questions do not help the nurse leader to evaluate the understanding level of the followers.
A client is admitted to the hospital after having a tonic-clonic seizure. The client has a two-year history of a seizure disorder, but the seizures have been well controlled by phenytoin for the last six months. The client says to the nurse, "I am so upset. I didn't think I was going to have more seizures." Which is the best response by the nurse? "Did you forget to take your medication?" "You are worried about having more seizures?" "You must be under a lot of stress right now." "Don't be too concerned
The response "You are worried about having more seizures?" addresses the client's feelings and encourages communication. The question "Did you forget to take your medication?" sounds accusatory; it ignores the client's feelings and discourages communication. Although the statement "You must be under a lot of stress right now" may be true, it does not encourage further communication concerning the seizure. The statement "Don't be too concerned because your medication needs to be increased" negates the client's feelings and discourages communication.
A nurse stops by the room of a newly admitted depressed client and offers to walk with the tearful client to the evening meal. The client looks intently at the nurse but says nothing. What is the best response by the nurse? "I'll be at the desk if you need me." "You must tell me what you're feeling now." "We'll walk together to dinner when you calm down." "It must be very difficult for you to be on a psychiatric unit."
The statement "It must be very difficult for you to be on a psychiatric unit" lets the client know that the nurse realizes that the client is having difficulty without asking direct questions or focusing on specific behavior. The response "I'll be at the desk if you need me" connotes avoidance. Saying "You must tell me what you're feeling now" sounds more like an order than an opportunity to express feelings. Saying "We'll walk together to dinner when you calm down" negates the client's feelings. The nurse should talk to the client without any expectation that the client will "calm down."
As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join and says, "I have nothing to talk about." What is the best response by the nurse? "Maybe tomorrow you'll feel more like talking." "Could you start off by talking about your family?" "A person like you has a great deal to offer the group." "You feel you won't be accepted unless you have something to say?"
The statement about the client's feelings of acceptance is a reflective statement that allows the client to either validate the statement or correct the nurse. Postponing the conversation delays addressing the problem and avoids exploring feelings. Asking the client to start talking about her or his family is a response that gives advice and does not allow the client to explore feelings. Stating that the client has a lot to offer the group denies the client's statement and does not allow the exploration of feelings.
The nurse as a leader provides feedback to a newly recruited nursing student after checking the student's progress report. Which action of the registered nurse is most closely aligned with the application of two-factor theory during the feedback session? Creating enthusiasm for practice Ignoring negative behaviors of the student nurse Promoting job enrichment by creating job satisfaction Providing specific feedback about positive performance
The two-factor theory of leadership indicates that motivating factors such as promoting job enrichment by creating job satisfaction inspire the work performance of the staff. Creating enthusiasm for staff practice characterizes the transformational theory of leadership. Ignoring the negative behaviors of student nurses indicates an application of the Organizational Behavior Modification theory of leadership. Providing specific feedback about positive performance indicates the application of the Expectancy theory of leadership.
