Therapeutic Communication Exam #2

ANS: C The nurse should give patient-feedback after an interview to help the patient feel connected and respected. Patients feel left out when nurses end an interview without giving them any indication of the assessment. Informing patients of what is happening, including plans and what patients can expect, provides helpful transitions so that they can map their progress, feel included, and minimize worrying about erroneous assumptions. The nurse should use simple language, avoid "why" questions, and use mostly open-ended questions.

An experienced nurse supervises a novice nurse interviewing a patient. The experienced nurse should intervene if which is observed? A. The novice nurse uses simple language instead of medical terms. B. The novice nurse avoids asking the patient "why" questions. C. The novice nurse leaves the patient without providing feedback. D. The novice nurse asks mostly open-ended health-history questions.

ANS: A, C The two major factors underlying a nurse's evaluation anxiety are concern for client safety (e.g., unsafe nursing practice) and concern for personal security (e.g., loss of job, loss of income).

Choose the examples of the major factors underlying evaluation anxiety experienced by nurses. (Select all that apply) a. Administering a medication incorrectly that results in a patient death. b. Difficulty using therapeutic communication techniques with patients. c. Losing a job because nursing care does not meet safety standards. d. Inability to accept constructive criticism from a supervisor. e. Fear of being accused of drug diversion.

ANS: A, C The two major factors underlying a nurse's evaluation anxiety are concern for client safety (e.g. unsafe nursing practice) and concern for personal security (e.g., loss of job, loss of income).

Choose the examples of the major factors underlying evaluation anxiety experienced by nurses. Select all that apply. A. Administering a medication incorrectly that results in a patient death. B. Difficulty using therapeutic communication techniques with patients. C. Losing a job because nursing care does not meet safety standards. D. Inability to accept constructive criticism from a supervisor. E. Fear of being accused of drug diversion.

ANS: A Health Care Apps is a cyberspace-based software (or application) accessed through a network device such as a smartphone. Apps provide clinicians with almost unlimited references at their hands instantly. Google Scholar is a search engine used by healthcare providers to locate journal articles. PubMed is used by healthcare providers to search for interdisciplinary professional journals from all types of medicine, nursing, pharmacology, etc. The electronic health record system (EHR) is usually a software application loaded into multiple computers through a hospital's intranet system.

The home health nurse uses a smartphone to access drug information while visiting patients. The nurse is using which form of electronic communication? a. Health Care Apps b. Google Scholar c. PubMed d. Electronic Health Record

ANS: D Physical symptoms that occur with evaluation anxiety include palpitations, increased heart rate, hyperventilation, and difficulty concentrating.

The nurse is anxious before meeting with the nurse manager for an annual performance evaluation. Which physical symptom would the nurse expect? A. Hypoventilation B. Increased concentration C. Decreased heart rate D. Palpitations

ANS: D Physical symptoms that occur with evaluation anxiety include palpitations, increased heart rate, hyperventilation, and difficulty concentrating.

The nurse is anxious before meeting with the nurse manager for an annual performance evaluation. Which physical symptom would the nurse expect? a. Hypoventilation b. Increased concentration c. Decreased heart rate d. Palpitations

ANS: B "REAL conversation: Recognize judgments. Express thoughts neutrally. Ask questions. Listen for verbal and nonverbal messages" (John Stoker, 2013).

REAL conversations, as described by John Stoker (2013), should contain multiple facets. As a nurse, we know when approaching patients, our care should be REAL, meaning we should do all of the following except: a. Recognize judgments b. Express biased thoughts c. Ask questions d. Listen for verbal and nonverbal messages

ANS: B The literature suggests that a positive relationship exists between the presence of social support and health and coping with illness (Komblith et al., 2001; Adams et al., 2000). A study of veterans demonstrated that perceived social support was associated with decreased incidence of post-traumatic stress disorder (Duax, Bohnert, Rauch, et al., 2014). Stroke survivors with higher perceived levels of social support scored higher on a health-related quality of life instrument (Kruithof, van Mierlo, Visser-Meily, et al., 2013). In a study of the work environment of secondary school teachers, co-worker support had an inverse relationship to anxiety and depression (Mahan et al., 2010).

Several studies have demonstrated that perceived social support is related to improved outcomes. When assessing your patients, you remembered that the textbook author had described research involving several different groups that had greater outcomes when social support was present. Which of the following was not one of those groups? a. Secondary school teachers b. Neighbors c. Veterans d. Stroke survivors

ANS: A Assessment of patient's need for information and level of understanding helps the nurse choose the right amount of detail and appropriate language level (Black, 2014).

The author describes the patient journey as driving down a country road and somehow getting lost. At that moment and time, all that is needed is clear directions about how to get to your destination, not about types of entertainment in the area. The same is true for patients. Accordingly, a part of each nursing assessment should include: a. Patient's need for information and level of understanding b. Detailed overview of disease process c. Specific examples from other patients with same disease d. Nurse's feelings about newest treatment modality

ANS: A, B, D, F The complexity of the health problems and the level of risk posed by patients, by their condition, or by the use of medical, nursing, or other therapies dictate the detail and frequency of documentation. The higher the risk to which a particular patient is exposed, the more comprehensive, in depth, and frequent should be the nursing recordings. Effective recording shuns bias, avoiding tendencies to prejudge or label patients. Avoidance of a malpractice suit is a valid reason for documentation to be detailed and specific, but documentation should be detailed and specific for every patient. Clear, concise documentation is vital for every entry into the electronic medical record. Careful documentation affects the ability of a healthcare agency to be reimbursed for services. Effective documentation tends toward quantitative expression, avoiding vague generalizations.

The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient's electronic medical record. Which key point should the nurse educator include in the teaching plan? (Select all that apply) a. A patient who is at high risk for falls will require more frequent documentation. b. The nurse should avoid labels (e.g., good, drug seeking, and lazy) to describe patients. c. Detailed and specific documentation is only required if a malpractice suit is expected. d. Each entry by the nurse in the electronic medical record should be clear and concise. e. Documentation cannot be used to determine reimbursement for healthcare services. f. Exact statements (in quotations) from patients are more accurate than paraphrasing.

ANS: B Eye contact is often cultural; some Native Americans believe that prolonged eye contact is rude and intrusive. However, it is important to assess each individual patient for preferences and comfort with eye contact.

The nurse is interviewing a Native American client. It is most important for the nurse to take which action? A. Maintain eye contact to show respect and interest. B. Assess whether the client is comfortable with eye contact. C. Avoid prolonged eye contact with this client. D. Sit next to the patient to avoid any eye contact.

ANS: D Muscle stretches augment the benefits of meditation and on-the-spot exercises; relaxation strategies are equally effective in reducing stress. Relaxation techniques can change feelings of tightness and fear to relaxation and a feeling of competence and create inner self-confidence. Imagery (e.g., of massage) can help a person cope with an unexpected stressful interpersonal encounter. Abdominal breathing is an on-the-spot method for relaxing the body.

The nurse teaches a client about relaxation techniques that can be used to reduce situational stress. Which statement by the client requires an intervention from the nurse? a. "Relaxation techniques can give me self-confidence and a feeling of competence." b. "If an angry person is going to talk to me, I can imagine myself getting a massage." c. "I should use abdominal breathing to help me relax in stressful situations." d. "Progressive stretching exercises are more effective than meditation to relieve stress."

ANS: E, B, A, C, D The following steps should be used to change negative self-talk to positive self-talk: 1) The nurse should develop an awareness of self-talk; 2) The nurse should determine if self-talk is positive or negative; 3) The nurse should learn how to stop negative self-talk; 4) The nurse should change internal dialogue to positive self-talk; and 5) The nurse should be able to perform positive self-talk without effort.

The nurse wants to communicate in a responsible and assertive manner by using positive self-talk. The steps to change self-talk from negative to positive appear below. Arrange the steps in the correct order of use. A. Learn how to stop negative self-talk. B. Assess whether self-talk is positive or negative. C. Change internal dialogue to positive self-talk. D. Perform positive self-talk without effort. E. Develop an awareness of self-talk.

ANS: D Positive self-talk emphasizes our strengths and our abilities to handle the situations confronting us, are assertive and responsible. This positive internal dialogue is assertive in its acknowledgment of our desire to handle situations effectively. Negative self-talk includes imagining the worst-case scenario. Negative self-talk about our ability to communicate or handle interpersonal situations is our destructive and self-defeating judgment. Talking to ourselves in encouraging, realistic ways increases our ability to communicate with others in assertive and responsible ways.

This chapter opened with the following quote: "Greatest weapon against stress is our ability to choose one thought over another." When describing the characteristics of positive self-talk to a group of nursing students, you would include all of the following descriptors except: a. Empathizes strengths and abilities b. Boosts confidence and facilitates the incorporation of new skills c. Assertive and responsible reactions d. Imagination of worst-case scenario

ANS: C Daily relaxation techniques (e.g., progressive relaxation, meditation) eliminate the negative build-up of stress and help nurses become more focused and alert, promoting safety for clients and for themselves. Stress is a result of unhealthy habits (e.g., eating processed foods, not taking breaks).

Which activity, if performed by the nurse, can improve patient safety? A. Pass up breaks to provide more time for patient care. B. Consume processed foods to increase energy level. C. Practice progressive relaxation exercises every day. D. Remain alert by not practicing meditation before work.

ANS: A Imagery is an effective intervention to control blood pressure, to promote coping, to optimize healing, and to improve the immune response.

Which change indicates to the nurse that a patient is responding favorably to using imagery? a. The patient's blood pressure is better controlled. b. The patient develops maladaptive coping strategies. c. The patient's healing time is increased. d. The patient's immune response is suppressed.

ANS: A, D, E Culture is the learned and shared beliefs, values, and lifeways of a particular group that are generally transmitted intergenerationally and influence one's thinking and actions. Ethnicity refers to the social identity and origins of a social group due largely to language, religion, and national origin. Ethnocentrism is the universal tendency of people to believe that one's own race or ethnic group is the most important and/or that some or all aspects of its culture are superior to those of other groups.

Which characteristic would the nurse use to define culture? Select all that apply. A. Learned and shared lifeways of a particular group. B. Social identity influenced by language and religion. C. Belief in superiority of one's own ethnic group. D. Values influence both thinking and actions. E. Several generations share the same beliefs.

ANS: A, B, D, F Evidence supports the use of humor in nursing practice to: 1) cope with conflicts between nurses and physicians; 2) help patients cope with disabilities; 3) establish relationships and rapport; 4) improve the patient's acceptance of the nurse; and 5) to help nurses intervene when patients are embarrassed. Humor may be inappropriate unless initiated by patients or family members.

Which function(s) of humor in nursing practice has been substantiated by research? Select all that apply. A. Conflicts that occur between nurses and physicians can be managed with humor. B. A patient with a disability may use humor as an effective coping strategy. C. The nurse should not use humor to intervene when a patient is embarrassed. D. A nurse can use humor to establish rapport with a patient who is anxious. E. Positive humor is most appropriate if initiated by the nurse and not the patient. F. Nurses who have a sense of humor are better accepted by patients.

ANS: A Spiritual care begins with being fully present; nursing presence is a conscious act of being fully present in body, mind, emotions, and spirit with a patient. Being silent and use of therapeutic touch are examples of being present. Performing tasks or assessments (e.g., obtaining a health history, administering medications) are not examples of being fully present. Spiritual care is more than religion or visitation from a chaplain.

Which nurse is being fully present with the patient to provide spiritual care? A. The nurse sits quietly with a patient and uses therapeutic touch. B. The nurse gathers a complete health history from a patient. C. The nurse asks if the patient would like the chaplain to visit. D. The nurse reassures a patient while giving medications.

ANS: A, C, D To avoid generating feelings of hostility or resentment, the nurse should ask colleagues if they are interested in hearing the nurse's viewpoint. The nurse should avoid being dogmatic or using strong phrases when expressing opinions. The nurse should be tentative about offering persuasions to show consideration of others' special circumstances. When offering an opinion, the nurse should give others a fair chance to accept or reject ideas. When expressing opinions to colleagues, the nurse should give the rationale in a responsible way; the nurse should offer a reason for his or her preferences and then turn the final decision back to the client.

Which three nurse statements are examples of expressing opinions in an assertive way with colleagues? (Select all that apply) a. "Do you think this project will help you learn about evidence-based practice?" b. "I will tell you about the evidence-based project, and you will want to help." c. "I recently attended an evidence-based conference. Can I share the highlights?" d. "I think we should be paid because this project will save money. What do you think?" e. "I really think you should read more evidence-based journal articles."

ANS: B, C, E The nurse should provide a concise statement as a rationale for questioning. If the nurse offers the patient options, the nurse should allow the patient time to speak and make a decision without interruptions. The nurse should not ask a string of questions because the patient may become confused and not know what information is important or where to begin answering. The nurse should not use medical terminology, abbreviations, or medical jargon that the patient does not understand. When asking the patient questions, the nurse should refrain from using "why" by rephrasing the question so it is softer and more receivable.

Which three technique(s) should be avoided when the nurse questions patients? (Select all that apply) a. Use questions that are worded clearly with words the patient understands. b. Provide a detailed explanation to introduce the rationale for the questions. c. Offer the patient options and tell the patient which option is preferred. d. Avoid asking a patient "why" by rephrasing the question if possible. e. Ask three to five questions at a time, and then allow the patient to answer.

ANS: C If there is any doubt as to whether the client will understand the nurse's reasons for asking questions, the nurse should explain those reasons in advance. If clients understand the purpose, they are more likely to be open and to reveal information, rather than being guarded because they are uneasy about the nurse's intentions. The client's caregiver can also be informed, but it is vital that the client is informed.

A client with metastatic cancer complains of severe, unrelieved pain even though appropriate pain medication has been prescribed. The home care nurse plans to ask the client questions to determine why the pain medication is not working. Which action would be most appropriate if the nurse doubts the client will understand the reason for asking these questions? A. Avoid asking any questions that might make the client feel uneasy or upset. B. Inform the client's caregiver to maintain trust in the nurse-client relationship. C. Tell the client that the questions will help to determine a better plan to control the pain. D. Refrain from disclosing the reason for asking the questions until the end of the visit.

ANS: B Simplicity of speech is recommended; use direct communication with few words. The nurse should not assume a subservient role to the physician; there needs to be a connection between communication, collaboration, and teamwork in the nurse-physician relationship to provide quality care. The nurse should be assertive, expect professional respect, and exude expertise.

A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective? A. Assume a subservient role to the physician. B. Use a direct approach with succinct sentences. C. Ask questions instead of making recommendations. D. Be polite and expect politeness from the physician.

ANS: B Simplicity of speech is recommended; use direct communication with few words. The nurse should not assume a subservient role to the physician; there needs to be a connection between communication, collaboration, and teamwork in the nurse-physician relationship to provide quality care. The nurse should be assertive, expect professional respect, and exude expertise.

A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective? a. Assume a subservient role to the physician. b. Use a direct approach with succinct sentences. c. Ask questions instead of making recommendations. d. Be polite and expect politeness from the physician.

ANS: B When giving advice, the RN should offer options as suggestions for the LPN/LVN's consideration. Suggestions will be more readily received if offered tentatively (e.g., "Something I've tried is this."). If the RN gives advice by telling the LPN/LVN how to change without giving the option to decide, the LPN/LVN's feelings may be hurt, or the LPN/LVN may not feel respected.

A licensed practical/vocational nurse (LPN/LVN) consistently forgets to administer medications and asks the registered nurse (RN) for specific advice. It is most appropriate for the RN to make which statement? A. "Buy a digital watch with an alarm, and you will never forget again." B. "Something that helps me is to set the alarm on my watch as a reminder." C. "You should set the alarm on your watch as a reminder to give medications." D. "It is best if you set the alarm on your watch when the next medication is due."

ANS: B When giving advice, the RN should offer options as suggestions for the LPN/LVN's consideration. Suggestions will be more readily received if offered tentatively (e.g., "Something I've tried is this."). If the RN gives advice by telling the LPN/LVN how to change without giving the option to decide, the LPN/LVN's feelings may be hurt, or the LPN/LVN may not feel respected.

A licensed practical/vocational nurse (LPN/LVN) consistently forgets to administer medications and asks the registered nurse (RN) for specific advice. It is most appropriate for the RN to make which statement? a. "Buy a digital watch with an alarm, and you will never forget again." b. "Something that helps me is to set the alarm on my watch as a reminder." c. "You should set the alarm on your watch as a reminder to give medications." d. "It is best if you set the alarm on your watch when the next medication is due."

ANS: C Nurses may feel powerless if decisions are made without their input or with which they disagree. Nurses can make a choice about when to share their disagreement even if they see no choice but to comply with the decision. Voicing disagreement makes the nurse feel more authentic and assertive. Assertiveness is a matter of choice and is not necessary or appropriate in every situation.

A new blood glucose bedside monitoring system is introduced at a staff meeting. A nurse who has previously used this system remembers that the meter would show error messages frequently. Which statement by the nurse demonstrates assertiveness? A. "Why did no one ask for my opinion? I should have been involved in this decision." B. "This meter does not work like it should, and I refuse to use this system ever again." C. "I had problems with this meter before, but I will use it and let you know what I think." D. "I have experience with this system, and there were never any serious problems."

ANS: C Nurses may feel powerless if decisions are made without their input or with which they disagree. Nurses can make a choice about when to share their disagreement even if they see no choice but to comply with the decision. Voicing disagreement makes the nurse feel more authentic and assertive. Assertiveness is a matter of choice and is not necessary or appropriate in every situation.

A new blood glucose bedside monitoring system is introduced at a staff meeting. A nurse who has previously used this system remembers that the meter would show error messages frequently. Which statement by the nurse demonstrates assertiveness? a. "Why did no one ask for my opinion? I should have been involved in this decision." b. "This meter does not work like it should, and I refuse to use this system ever again." c. "I had problems with this meter before, but I will use it and let you know what I think." d. "I have experience with this system, and there were never any serious problems."

ANS: C Affective support is acknowledgment for the work a nurse does and a feeling of nurturance; the graduate nurse would seek affective support using an assertive approach if a lack of empathy, reassurance, and positive feedback were identified. Cognitive support helps the nurse think intelligently and solve problems. Physical support is the provision of staff, materials, and processes needed to get the work done. Nonassertive, aggressive, or antagonistic approaches are not effective to gain support.

A new graduate nurse feels that the staff nurses are not empathetic and do not provide reassurance or positive feedback. Which action by the graduate nurse is appropriate? A. Use an antagonistic approach to seek support from a nurse who is a mentor. B. Use a nonassertive approach to seek physical support from the staff nurses. C. Use an assertive approach to seek affective support from the nurse manager. D. Use an aggressive approach to seek cognitive support from other graduate nurses.

ANS: C Affective support is acknowledgment for the work a nurse does and a feeling of nurturance; the graduate nurse would seek affective support using an assertive approach if a lack of empathy, reassurance, and positive feedback were identified. Cognitive support helps the nurse think intelligently and solve problems. Physical support is the provision of staff, materials, and processes needed to get the work done. Nonassertive, aggressive, or antagonistic approaches are not effective to gain support.

A new graduate nurse feels that the staff nurses are not empathetic and do not provide reassurance or positive feedback. Which action by the graduate nurse is appropriate? a. Use an antagonistic approach to seek support from a nurse who is a mentor. b. Use a nonassertive approach to seek physical support from the staff nurses. c. Use an assertive approach to seek affective support from the nurse manager. d. Use an aggressive approach to seek cognitive support from other graduate nurses.

ANS: B Humor improves the patient's ability to cope with stress and fear. Droll humor is more effective than formal jokes. Humor may help to put a patient at ease during a bath. Humor invites interaction.

A nurse instructs colleagues about the use of humor with patients. Which statement, if made by a colleague, indicates that the teaching is effective? a. "Telling a joke is the best way to use humor." b. "Humor can help patients to be less afraid." c. "I should avoid humor when giving a bath." d. "Patients will not talk to me if I use humor."

ANS: D The new nurse should be specific when requesting feedback by clarifying the aspects of a behavior (i.e., assessment accuracy). The new nurse should avoid vague questions (e.g., "How do you think I am doing?"). The new nurse should not ask for feedback until confident enough to examine the feedback. Receiving feedback with implications for change when unconfident may only serve to make the new nurse feel worse.

A new nurse wants feedback from the other more experienced nurses on the unit. Which request for feedback, if made by the new nurse, would be most appropriate? A. "How do you think I am doing?" B. "I would like to know my strengths and weaknesses." C. "I still feel incompetent but would like some feedback." D. "What do you think about the accuracy of my assessments?"

ANS: D The new nurse should be specific when requesting feedback by clarifying the aspects of a behavior (i.e., assessment accuracy). The new nurse should avoid vague questions (e.g., "How do you think I am doing?"). The new nurse should not ask for feedback until confident enough to examine the feedback. Receiving feedback with implications for change when unconfident may only serve to make the new nurse feel worse.

A new nurse wants feedback from the other more experienced nurses on the unit. Which request for feedback, if made by the new nurse, would be most appropriate? a. "How do you think I am doing?" b. "I would like to know my strengths and weaknesses." c. "I still feel incompetent but would like some feedback." d. "What do you think about the accuracy of my assessments?"

ANS: A Nurses need to know about culture because it influences both nurses' and clients' health care perceptions and behaviors. Nurses should learn about the culture of diverse clients and communities. Nurses need to recognize and overcome certain attitudes basic to the American culture. To provide culturally competent care, the nurse must address issues of discrimination. Learning how to speak another language is important, but it is more important to seek understanding of cultural influences on health.

A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? A. Discover cultural influences on health care perceptions and behaviors. B. Assist the patients to adapt to American culture and health beliefs. C. Avoid confrontation of underlying issues of discrimination. D. Improve communication by learning how to speak Spanish.

ANS: A As our society becomes more global and diverse, cultural competence is a dynamic concept that must be evaluated continuously as it relates to patient outcomes (Waite et al., 2014). Nurses need to know about culture because it influences both nurses' and clients' healthcare perceptions and behaviors. Nurses should learn about the culture of diverse clients and communities. Nurses need to recognize and overcome certain attitudes basic to the American culture. To provide culturally competent care, the nurse must address issues of discrimination. Learning how to speak another language is important, but it is more important to seek understanding of cultural influences on health.

A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? a. Discover cultural influences on healthcare perceptions and behaviors. b. Assist the patients to adapt to American culture and health beliefs. c. Avoid confrontation of underlying issues of discrimination. d. Improve communication by learning how to speak Spanish.

ANS: C Research supports the idea that imagery works because the brain does not distinguish between an image and the experience of the imagined place or situation. Imagery is most successful if the visualization is clear and the course of action is committed; there should be neither limitations nor constraints. Not everyone images the same way. Some individuals are actively involved in the image, while others see it as actors on a stage or get only sensory impressions without a clear image. Imagery or visualization is a process of mentally picturing an event we wish to occur in the present or future.

A nurse attends an education session on effective communication. Which statement, if made by the nurse, indicates an understanding of how imagery may be used to build confidence when communicating with patients and colleagues? a. "Imagery is most successful if visualizations are ambiguous and constrained." b. "Imagery will only be effective if individuals are actively involved in the visualizations." c. "Imagery works because the brain does not discriminate between thoughts and actions." d. "Imagery is a process of using pictures to remember past events with positive regard."

ANS: B Internal dialogue (or self-talk) is a continuous and powerful influence on a person's well-being and performance. Internal dialogue can be destructive and cause problems when it is irrational, unrealistic, or ineffective. The nursing student who tells herself that she is dim-witted may never be able to develop accurate assessment skills. Other statements by the nursing student demonstrate positive self-talk which is constructive and will most likely lead to improved and accurate patient assessments.

A nurse constantly tells a nursing student that she is not able to complete her patient assessments accurately. Which statement, if made by the nursing student to herself, indicates that her internal dialogue is negative? A. "Normal assessments are easy; I can learn the abnormal." B. "I am dim-witted when it comes to making assessments." C. "That nurse obviously does not know me very well." D. "I can make it as a nurse; I just need more practice."

ANS: B Internal dialogue (or self-talk) is a continuous and powerful influence on a person's well-being and performance. Internal dialogue can be destructive and cause problems when it is irrational, unrealistic, or ineffective. The nursing student who tells herself that she is dim-witted may never be able to develop accurate assessment skills. Other statements by the nursing student demonstrate positive self-talk that is constructive and will most likely lead to improved and accurate patient assessments.

A nurse constantly tells a nursing student that she is not able to complete her patient assessments accurately. Which statement, if made by the nursing student to herself, indicates that her internal dialogue is negative? a. "Normal assessments are easy; I can learn the abnormal." b. "I am dim-witted when it comes to making assessments." c. "That nurse obviously does not know me very well." d. "I can make it as a nurse; I just need more practice."

ANS: B Humor improves the patient's ability to cope with stress and fear. Droll humor is more effective than formal jokes. Humor may help to put a patient at ease during a bath. Humor invites interaction.

A nurse instructs colleagues about the use of humor with patients. Which statement, if made by a colleague, indicates that the teaching is effective? A. "Telling a joke is the best way to use humor." B. "Humor can help patients to be less afraid." C. "I should avoid humor when giving a bath." D. "Patients will not talk to me if I use humor."

ANS: B If the nurse develops a specific and clear plan with sufficient detail, the greater are the chances of obtaining physical support (e.g., a private area). Demanding a space is an aggressive approach that does not give respect to the nursing director. The nurse should make an appointment with the nursing supervisor or manager and not communicate by e-mail or letter. The nurse should not just describe the problem but also offer solutions.

A nurse is breastfeeding but has no private, sanitary area to pump breast milk while working. She also discovers that at least 10 other employees at the hospital have the same problem. Which action by the nurse would most likely result in acquiring a clean, private area to pump breast milk as required by law? a. The nurse demands that the nursing director provide a private area within 1 week. b. The nurse develops a clear, detailed plan and suggests several possible private areas. c. The nurse sends an e-mail to the nursing supervisor with a description of the problem. d. The nurse writes a letter to the nurse manager and asks others to add their signatures.

ANS: B If the nurse develops a specific and clear plan with sufficient detail, the greater are the chances of obtaining physical support (e.g., a private area). Demanding a space is an aggressive approach that does not give respect to the nursing director. The nurse should make an appointment with the nursing supervisor or manager and not communicate by e-mail or letter. The nurse should not just describe the problem but also offer solutions.

A nurse is breastfeeding but has no private, sanitary area to pump breast milk while working; she also discovers that at least 10 other employees at the hospital have the same problem. Which action by the nurse would most likely result in acquiring a clean, private area to pump breast milk? A. The nurse demands that the nursing director provide a private area within one week. B. The nurse develops a clear, detailed plan and suggests several possible private areas. C. The nurse sends an e-mail to the nursing supervisor with a description of the problem. D. The nurse writes a letter to the nurse manager and asks others to add their signatures.

ANS: A, C, D The nurse informatician must be able to integrate nursing science, computer science, and information science. In addition, the nurse should have education and experience in both clinical nursing and information technology. Software development and social media experience are non-essential skills for the nurse informatician.

A nurse is employed at a hospital as a nurse informatician. Which skill(s) are necessary for this professional role? (Select all that apply) a. Clinical expertise in nursing b. Experience with social media c. Understanding of information technology d. Computer knowledge and experience e. Electronic medical record software development

ANS: B To improve the ability to be at ease when asking questions in a variety of areas, the nurse may rehearse with friends or colleagues. If the nurse cannot overcome being uncomfortable with asking sexual questions, the nurse should be honest with the patient or have another nurse interview the patient. The nurse should not avoid asking questions regarding sexual behavior.

A nurse is uncomfortable asking patients about their sexual practices and behaviors. It is most appropriate for the nurse to take which action? A. Avoid asking these questions unless the patient initiates a discussion on sexual behaviors. B. Practice asking these types of questions in a simulated situation with a colleague. C. Ask a nurse who is comfortable with these types of questions to interview the patient. D. Tell the patient that asking sexual questions is difficult and uncomfortable for a nurse.

ANS: B To improve the ability to be at ease when asking questions in a variety of areas, the nurse may rehearse with friends or colleagues. If the nurse cannot overcome being uncomfortable with asking sexual questions, the nurse should be honest with the patient or have another nurse interview the patient. The nurse should not avoid asking questions regarding sexual behavior.

A nurse is uncomfortable when asking patients about their sexual practices and behaviors. It is most appropriate for the nurse to take which action? a. Avoid asking these questions unless the patient initiates a discussion on sexual behaviors. b. Practice asking these types of questions in a simulated situation with a colleague. c. Ask a nurse who is comfortable with these types of questions to interview the patient. d. Tell the patient that asking sexual questions is difficult and uncomfortable for a nurse.

ANS: C Giving advice is a unilateral process of solving problems or making decisions for others; giving advice prevents patients from becoming independent. Assertive communication occurs when nurses express opinions or offer recommendations. Expressing opinions assists patients in their decision making and fosters independence. Having confidence in the ability to communicate can help prevent miscommunication, a significant threat to the safety of hospitalized patients.

A nurse manager has set a goal to improve professional communication on the unit. The staff nurses have attended a session on how to distinguish between expressing opinions and giving advice. Which statement, if made by a staff nurse, indicates that further teaching is needed? A. "Nurses who express opinions give patients the opportunity to make choices." B. "Patient safety is enhanced if nurses have confidence in their ability to communicate." C. "Giving advice leads to independent decision making by patients." D. "Expressing opinions or recommendations is an assertive behavior."

ANS: C Giving advice is a unilateral process of solving problems or making decisions for others; giving advice prevents patients from becoming independent. Assertive communication occurs when nurses express opinions or offer recommendations. Expressing opinions assists patients in their decision making and fosters independence. Having confidence in the ability to communicate can help prevent miscommunication, a significant threat to the safety of hospitalized patients.

A nurse manager has set a goal to improve professional communication on the unit. The staff nurses have attended a session on how to distinguish between expressing opinions and giving advice. Which statement, if made by a staff nurse, indicates that further teaching is needed? a. "Nurses who express opinions give patients the opportunity to make choices." b. "Patient safety is enhanced if nurses have confidence in their ability to communicate." c. "Giving advice leads to independent decision making by patients." d. "Expressing opinions or recommendations is an assertive behavior."

ANS: A A mentoring program can provide cognitive and affective support; mentor programs have improved retention of nurses. Cognitive, affective, and physical support are equally important to reduce stress and promote retention of nurses. Affective support is acknowledgment for the work nurses do; respect, honor, and recognition should be continually provided and not just during annual reviews or evaluations. Physical support is provided with having the staff, materials, and processes to complete the work; however, staffing is an essential component of physical support and directly linked to retention of nurses.

A nurse manager seeks to reduce staff nurses' stress and promote retention. It is most important for the nurse manager to take which action? A. Develop a mentoring program to provide cognitive and affective support. B. Focus on cognitive support instead of affective or physical support. C. Limit affective support to annual recognition of nurses' accomplishments. D. Place the highest priority on purchasing equipment to provide for physical support.

ANS: A A mentoring program can provide cognitive and affective support; mentor programs have improved retention of nurses. Cognitive, affective, and physical support are equally important to reduce stress and promote retention of nurses. Affective support is acknowledgment for the work nurses do; respect, honor, and recognition should be continually provided and not just during annual reviews or evaluations. Physical support is provided with having the staff, materials, and processes to complete the work; however, staffing is an essential component of physical support and directly linked to retention of nurses.

A nurse manager seeks to reduce staff nurses' stress and promote retention. It is most important for the nurse manager to take which action? a. Develop a mentoring program to provide cognitive and affective support. b. Focus on cognitive support instead of affective or physical support. c. Limit affective support to annual recognition of nurses' accomplishments. d. Place the highest priority on purchasing equipment to provide for physical support.

ANS: A Affirmations are positive self-talk statements of what the nurse wants, written in the present tense, as if they have already happened. Affirmations can help the nurse take an optimistic point of view about life and work. Statements should be written, short, and very specific. The nurse should believe that the affirmation is happening. In addition, the affirmations should be repetitive and be reviewed at a specific time on a daily basis.

A nurse wants to remain hopeful and optimistic when working with hospice patients. Which would be appropriate affirmations for the nurse to use? A. Write down short, specific positive statements. B. Review written, positive statements two to three times per month. C. Develop a new positive statement every two to three days. D. Use statements that refer to positive actions that will occur in the future.

ANS: A Affirmations are positive self-talk statements of what the nurse wants, written in the present tense, as if they have already happened. Affirmations can help the nurse take an optimistic point of view about life and work. Statements should be written, short, and very specific. The nurse should believe that the affirmation is happening. In addition, the affirmations should be repetitive and be reviewed at a specific time on a daily basis.

A nurse wants to remain hopeful and optimistic when working with hospice patients. Which would be appropriate affirmations for the nurse to use? a. Write down short, specific positive statements. b. Review written, positive statements 2 to 3 times per month. c. Develop a new positive statement every 2 to 3 days. d. Use statements that refer to positive actions that will occur in the future.

ANS: A, B, E Nurses need to know when to express opinions and when not to share opinions and have the strength not to always be right. The nurse should not share opinions when it does not make a difference (e.g., insignificant differences in blood pressure readings, taking an extra 3 minutes for lunch, mispronunciation of medical terms with colleagues). Opinions should be expressed if patient safety is involved (e.g., administering medication by the wrong route) or there are legal ramifications (e.g., a controlled substance is missing).

A nurse who frequently corrects other staff nurses is trying to avoid making comments when it really does not matter. In which situation(s) would it be appropriate for the nurse to remain silent and not share an opinion? Select all that apply. A. A staff nurse reports a blood pressure as 110/60 but it is recorded in the chart as 114/62. B. A staff nurse takes a lunch break for 33 minutes instead of 30 minutes. C. A staff nurse gives a medication orally instead of by injection. D. A staff nurse reports no discrepancy for the narcotic count, but one is missing. E. A staff nurse does not pronounce the generic name of a medication correctly.

ANS: A, B, E Nurses need to know when to express opinions and when not to share opinions and have the strength not to always be right. The nurse should not share opinions when it does not make a difference (e.g., insignificant differences in blood pressure readings, taking an extra 3 minutes for lunch, and mispronunciation of medical terms with colleagues). Opinions should be expressed if patient safety is involved (e.g., administering medication by the wrong route) or there are legal ramifications (e.g., a controlled substance is missing).

A nurse who frequently corrects other staff nurses is trying to avoid making comments when it really does not matter. In which three situation(s) would it be appropriate for the nurse to remain silent and not share an opinion? (Select all that apply) a. A staff nurse reports a blood pressure as 110/60, but it is recorded in the chart as 114/62. b. A staff nurse takes a lunch break for 33 minutes instead of 30 minutes. c. A staff nurse gives a medication orally instead of by injection. d. A staff nurse reports no discrepancy for the narcotic count, but one is missing. e. A staff nurse does not pronounce the generic name of a medication correctly.

ANS: B Positive self-talk is an approach that can help the nurse to overcome evaluation anxiety; this approach will replace self-defeating internal dialogue with a reassuring inner voice that is comforting. It is unrealistic to set a goal to avoid all errors and always provide safe nursing care; this standard requires perfection and may actually increase tension and anxiety. The nurse manager should be given uninterrupted time to provide comments before the nurse shares professional goals. If the nurse manager has suggestions about ways in which the nurse can improve performance, the nurse should only agree to those changes that are realistic and supported by the workplace.

A nurse who is extremely anxious about an upcoming evaluation with the nurse manager asks a mentor who is an experienced nurse for advice. Which approach should the mentor recommend to control evaluation anxiety? A. Avoid making medication errors and always provide safe nursing care. B. Practice positive self-talk daily and during the evaluation. C. Articulate your goals before the nurse manager gives feedback. D. Agree to the suggestions given by the nurse manager on how to improve.

ANS: B Positive self-talk is an approach that can help the nurse to overcome evaluation anxiety; this approach will replace self-defeating internal dialogue with a reassuring inner voice that is comforting. It is unrealistic to set a goal to avoid all errors and always provide safe nursing care; this standard requires perfection and may actually increase tension and anxiety. The nurse manager should be given uninterrupted time to provide comments before the nurse shares professional goals. If the nurse manager has suggestions about ways in which the nurse can improve performance, the nurse should only agree to those changes that are realistic and supported by the workplace.

A nurse who is extremely anxious about an upcoming evaluation with the nurse manager asks a mentor who is an experienced nurse for advice. Which approach should the mentor recommend to control evaluation anxiety? a. Avoid making medication errors and always provide safe nursing care. b. Practice positive self-talk daily and during the evaluation. c. Articulate your goals before the nurse manager gives feedback. d. Agree to the suggestions given by the nurse manager on how to improve.

ANS: D If a healthcare provider is not able to remember his or her password to access electronic healthcare records, the individual should contact the designated person to obtain a new password. Healthcare providers should not share passwords or document under another individual's password. Healthcare providers should never document for another person.

A nursing assistant cannot remember the password for the hospital computer to chart vital signs and personal care given to patients. Which response by the nurse supervising the nursing assistant is most appropriate? a. "I will give you my password so you can chart before you leave." b. "Look up your password, and chart the information tomorrow." c. "If you write down the information, I will chart for you." d. "You will need to obtain your password from the computer specialist."

ANS: C Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. Dependency is a situation in which immediacy is appropriate in the nurse-client relationship. If the patient is unable to make a decision and wants advice from the nurse, the nurse should acknowledge the dependency and state that information can be provided, but the decision will be made by the patient. It is within the scope of practice of a nurse to provide information about medications. The nurse should not disclose personal information or experiences in situations of dependency.

A patient asks the nurse to make a decision for her about whether or not to continue taking hormone replacement therapy (estrogen). Which response by the nurse is most appropriate? A. "You should check with a doctor; I cannot give you advice about drugs." B. "My friend has taken estrogen for more than five years without any problems." C. "I can answer any questions you have but it is up to you to make this decision." D."Herbal supplements were much better for me than prescription-strength estrogen."

ANS: C Attraction may occur if the client attempts to turn a professional relationship into a social relationship. Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. The nurse should tell the client that it is important for the relationship to remain professional. The nurse should not encourage the client's behavior; attraction does not build trust in the nurse-client relationship. The nurse should attempt to talk with the patient instead of avoidance by either requesting a different patient assignment or transferring the patient to another unit.

A patient is attracted to the nurse and attempts to initiate a social relationship. It is most appropriate for the nurse to take which action? A. Encourage the client's behavior to develop a trusting nurse-client relationship. B. Inform the charge nurse of the situation and ask for a different patient assignment. C. Tell the patient that the relationship must remain professional at all times. D. Determine if the patient can be transferred to another nursing care unit.

ANS: C If humor is used, and it offends the patient, the nurse should apologize and explain that the intention was to be helpful. If the patient is offended, the nurse should not continue to use humor. The nurse should not tell a patient how to feel or behave (e.g., "you need to lighten up" or "try to at least smile") or suggest that certain behaviors will increase pain.

A patient who is scheduled for open heart surgery is nervous and tense. The nurse tries to use humor to reduce tension, but the patient seems offended. Which response by the nurse is most appropriate? A. "That joke usually works to relieve tension. Let me try another one to make you laugh." B. "You need to lighten up a little bit because patients who are anxious have more pain." C. "I was trying to ease your tension about surgery, and I am sorry for my insensitivity." D. "Haven't you ever heard that laughter is the best medicine? Just try to at least smile."

ANS: C If humor is used, and it offends the patient, the nurse should apologize and explain that the intention was to be helpful. If the patient is offended, the nurse should not continue to use humor. The nurse should not tell a patient how to feel or behave (e.g., "you need to lighten up" or "try to at least smile") or suggest that certain behaviors will increase pain.

A patient who is scheduled for open heart surgery is nervous and tense. The nurse tries to use humor to reduce tension, but the patient seems offended. Which response by the nurse is most appropriate? a. "That joke usually works to relieve tension. Let me try another one to make you laugh." b. "You need to lighten up a little bit because patients who are anxious have more pain." c. "I was trying to ease your tension about surgery, and I am sorry for my insensitivity." d. "Haven't you ever heard that laughter is the best medicine? Just try to at least smile."

ANS: C To experience benefits from meditation, it is desirable to meditate for 15 to 20 minutes at least once a day. This commitment means setting aside that time consistently. Although meditation is rooted in spiritual traditions, the practice of meditation does not require belief in any particular religious or cultural system. Distracting thoughts are likely to occur during meditation, especially at first; the nurse should let these thoughts pass without becoming worried. Meditation can help the nurse learn to maintain a calm perspective, but meditation is not practical while on the unit.

A supervisor instructs a nurse on how to use meditation to relax and to reduce stress. Which statement, if made by the nurse, indicates teaching is successful? A. "I can use meditation to reduce tension if stressful situations occur on the unit." B. "If distracting thoughts occur while meditating, I will focus on these thoughts." C. "I should practice meditation for at least 15 minutes every day." D. "Meditation is most effective for people with strong religious beliefs."

ANS: C To experience benefits from meditation, it is desirable to meditate for 15 to 20 minutes at least once a day. This commitment means setting aside that time consistently. Although meditation is rooted in spiritual traditions, the practice of meditation does not require belief in any particular religious or cultural system. Distracting thoughts are likely to occur during meditation, especially at first; the nurse should let these thoughts pass without becoming worried. Meditation can help the nurse learn to maintain a calm perspective, but meditation is not practical while on the unit.

A supervisor instructs a nurse on how to use meditation to relax and to reduce stress. Which statement, if made by the nurse, indicates teaching is successful? a. "I can use meditation to reduce tension if stressful situations occur on the unit." b. "If distracting thoughts occur while meditating, I will focus on these thoughts." c. "I should practice meditation for at least 15 minutes every day." d. "Meditation is most effective for people with strong religious beliefs."

ANS: B It is important to focus on the aspects of nutrition that the teacher wants the students to know and that are most important for them. The nurse should not assume the students need to learn about nutrition labels or obesity. Comprehensive nutrition information may waste time, be irrelevant, or focus on material that is too frightening or too advanced.

A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate? A. "I will teach the students how to read nutrition labels." B. "What would you like the students to learn about nutrition?" C. "The students need to know about the consequences of obesity." D. "I will enjoy teaching the students everything I know about nutrition."

ANS: B It is important to focus on the aspects of nutrition that the teacher wants the students to know and that are most important for them. The nurse should not assume the students need to learn about nutrition labels or obesity. Comprehensive nutrition information may waste time, be irrelevant, or focus on material that is too frightening or too advanced.

A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate? a. "I will teach the students how to read nutrition labels." b. "What would you like the students to learn about nutrition?" c. "The students need to know about the consequences of obesity." d. "I will enjoy teaching the students everything I know about nutrition."

ANS: C An empathetic response is accurate and specific. The word "worry" accurately reflects verbal and nonverbal cues from the mother. The other statements by the nurse do not accurately reflect the mother's verbal and nonverbal cues.

A young mother who fractured her leg is sobbing with her face hidden behind her hands. She says to the nurse, "I will not be able to work for at least 2 months. Without my job, I cannot pay my bills or take care of my baby. I am alone and do not have anyone to help me." Which response by the nurse accurately conveys empathy? A. "Why do you think that no one cares about you or will refuse to help you?" B. "I can see that you are hesitant about relying on others because of low self-esteem." C. "You seem worried about how you will be able to take care of yourself and your baby." D. "I am sorry that you are uncomfortable with asking others for help right now."

ANS: D Over 250 studies show that religious practice (e.g., faith and regular prayer) is correlated with greater health and increased longevity. The patient is not asking what the nurse believes about prayer; the patient is asking about evidence relating faith and prayer to health and longevity. It is within the scope of practice for the nurse to address spiritual issues in clinical practice. Findings from over 70 data-based, peer-reviewed published papers show that people who attend religious services on a regular basis have better health outcomes, stronger immune systems, lower stress, and recover from hip fractures and open-heart surgeries more quickly than do less religious people.

An elderly patient asks the nurse if faith and regular prayer have any effect on health and longevity. Which response by the nurse is most appropriate? A. "It doesn't matter what I think, because your beliefs about religion are most important." B. "You will need to ask a chaplain because I am not allowed to discuss religion." C. "Health benefits are only associated with individuals who attend church every week." D. "There is evidence that religious practices are associated with health and living longer."

ANS: D Over 250 studies show that religious practice (e.g., faith and regular prayer) is correlated with greater health and increased longevity. The patient is not asking what the nurse believes about prayer; the patient is asking about evidence relating faith and prayer to health and longevity. It is within the scope of practice for the nurse to address spiritual issues in clinical practice. Findings from over 70 data-based, peer-reviewed published papers show that people who attend religious services on a regular basis have better health outcomes, stronger immune systems, lower stress, and recover from hip fractures and open-heart surgeries more quickly than do less religious people.

An elderly patient asks the nurse if faith and regular prayer have any effect on health and longevity. Which response by the nurse is most appropriate? a. "It doesn't matter what I think, because your beliefs about religion are most important." b. "You will need to ask a chaplain because I am not allowed to discuss religion." c. "Health benefits are only associated with individuals who attend church every week." d. "There is evidence that religious practices are associated with health and living longer."

ANS: C The nurse should give patient feedback after an interview to help the patient feel connected and respected. Patients feel left out when nurses end an interview without giving them any indication of the assessment. Informing patients of what is happening, including plans and what patients can expect, provides helpful transitions so that they can map their progress, feel included, and minimize worrying about erroneous assumptions. The nurse should use simple language, avoid "why" questions, and use mostly open-ended questions.

An experienced nurse supervises a novice nurse interviewing a patient. The experienced nurse should intervene if which is observed? a. The novice nurse uses simple language instead of medical terms. b. The novice nurse avoids asking the patient "why" questions. c. The novice nurse leaves the patient without providing feedback. d. The novice nurse asks mostly open-ended health history questions.

ANS: B Many of life's treasures remain hidden from us simply because we never search for them. Often we do not ask the proper questions that might lead us to the answer to all our challenges (Andy Andrews, 2011). He did not recommend ruminating about alternatives, utilizing negative self-task, or increasing your self-advocacy.

Andy Andrews, a well-known author and speaker, was once homeless and lived on the streets for a season of his life. Discussing the lessons learned as he looked back over his journey, he was quoted as recommending one of the following as a key to moving forward: a. Ruminating about alternatives b. Asking proper questions c. Utilizing negative self-talk d. Increasing your self-advocacy

ANS: D "Wacky Wednesday" is a humor intervention successfully used to decrease the anxiety levels of children having outpatient surgery and their parents. A mother who had previously lost her daughter to cancer initiated a day for staff, patients, and family to get "wacky" by dressing in costumes and using other props from her humor cart. From the positive results of an 18-month study of this intervention, a Child Life Specialist was placed in the out-patient department full time, and the staff, too, continued using humor interventions (Berger, Wilson, Potts, and Polivka, 2014).

As initiated at one children's hospital, Wacky Wednesday successfully decreased anxiety levels for children facing surgery, as well as their parents. As such, the nursing instructor encourages students to include an element of this into their nursing care plan. Wacky Wednesday is an example of a: a. Social experiment b. Empathic response c. Humorous addition d. Humor intervention

ANS: B Behavioral science tells us that whatever behavior we reward will be strengthened or repeated. Remember to take time to comment on what your colleagues do that makes your day easier. Nurse managers can encourage staff by saying thank you; looking for what is going well; and sharing how much they are appreciated (Lorenz, 2013). Pointing out mistakes in front of others would not strengthen your team.

Strongly supporting your peers on a nursing unit builds trust and camaraderie. In fact, it is the relationship that is built during the quiet days that we draw upon during stressful times, such as a cardiac code. Whether you are a manager or a peer, you can strengthen your team by all of the following except: a. Saying thank you b. Pointing out mistakes in front of others c. Looking for what is going well d. Sharing how much they are appreciated

ANS: B According to Povine conducting laughter research, babies laugh 300 times each day (Dutton, 2012). How often does a typical adult laugh? About 20 times per day.

The author said that laughter is an instant vacation, but as nurses, incorporating humor into our daily work can be a challenge. One of the reasons for this, according to Povine's research as presented by Dutton (2012), is that for adults, laughter does not come as easily as it did for them when they were young. How much more do babies laugh than adults? a. 50 times more b. 15 times more c. 10 times more d. 100 times more

ANS: A, B, D, F The complexity of the health problems and the level of risk posed by patients, by their condition, or by the use of medical, nursing, or other therapies dictate the detail and frequency of documentation. The higher the risk to which a particular patient is exposed, the more comprehensive, in depth, and frequent should be the nursing recordings. Effective recording shuns bias, avoiding tendencies to prejudge or label patients. Avoidance of a malpractice suit is a valid reason for documentation to be detailed and specific, but documentation should be detailed and specific for every patient. Clear, concise documentation is vital for every entry into the electronic medical record. Careful documentation affects the ability of a health care agency to be reimbursed for services. Effective documentation tends toward quantitative expression, avoiding vague generalizations.

The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient's electronic medical record. Which key point should the nurse educator include in the teaching plan? Select all that apply. A. A patient who is at high risk for falls will require more frequent documentation. B. The nurse should not use labels (e.g., good, drug-seeking, lazy) to describe patients. C. Detailed and specific documentation is only required if a malpractice suit is expected. D. Each entry by the nurse in the electronic medical record should be clear and concise. E. Documentation cannot be used to determine reimbursement for health care services. F. Exact statements (in quotations) from patients are more accurate than paraphrasing.

ANS: C Evaluation of basic computer skills of the staff nurses is a priority before starting electronic medical record (EMR) training. Electronic bar-code medication administration can be implemented either before or after EMRs. Digital pictures can provide visible evidence to support documentation, but it is more important to assess the nurses' computer skills. Timely charting is important with EMR because other healthcare providers are able to access patient information; this information must be up-to-date because decisions are made based on this data. EMRs should be designed around the nurse's workflow.

The hospital nurse managers are planning for the implementation of electronic medical records for documentation by the staff nurses. The nurse managers should take which action first? a. Initiate electronic bar-code medication administration. b. Teach the nurses to use a digital camera to supplement charting. c. Determine the computer skills of the staff nurses. d. Alter nursing workflow to accommodate timely charting.

ANS: B Rapport should be established before bad news is shared with the family; if rapport has not been developed, the nurse may ask team members who have established rapport with the family to be present. The nurse should use language that the family will understand. Find out how much detail the family wants to know. Explain the treatment plan to the family.

The nurse cares for a patient who becomes confused and a vest restraint is applied. The nurse should take which action when notifying the patient's family? A. Avoid discussing the treatment plan to reduce anxiety and worry. B. Ask another nurse who has rapport with the family to be present. C. Use medical terms to demonstrate competence. D. Assume that the family wants a detailed explanation.

ANS: D To obtain specific information, the nurse must specifically ask for it (e.g., ask the patient about possible causes for the pain). It is more appropriate for the nurse to initially ask for the patient's perspective than about specific causes (e.g., osteoporosis or activity). The nurse should assess before taking action (e.g., offering pain medication); the intervention does not provide specific information about the back pain.

The nurse cares for a patient who complains of back pain. Which question should the nurse ask to obtain specific information about the back pain? A. "Would you like medication for the pain?" B. "What have you been doing in the last few days?" C. "Do you have a family history of osteoporosis?" D. "What do you think caused the back pain?"

ANS: D To obtain specific information, the nurse must specifically ask for it (e.g., ask the patient about possible causes for the pain). It is more appropriate for the nurse to initially ask for the patient's perspective than about specific causes (e.g., osteoporosis or activity). The nurse should assess before taking action (e.g., offering pain medication); the intervention does not provide specific information about the back pain.

The nurse cares for a patient who complains of back pain. Which question should the nurse ask to obtain specific information about the back pain? a. "Would you like medication for the pain?" b. "What have you been doing in the last few days?" c. "Do you have a family history of osteoporosis?" d. "What do you think caused the back pain?"

ANS: C The nurse gives feedback respectfully, if phrases such as "From my perspective ..." are used; the nurse uses the first person to convey thoughts and feelings which prevents accusing or labeling the patient's behavior. The nurse should not give feedback to display superior knowledge or to rigidly control the behavior of a patient. The nurse should gain permission from the patient to give feedback. The nurse should not give feedback that is general; feedback should focus on specific, observable behavior.

The nurse cares for a patient who is admitted to the medical unit. The patient has type 2 diabetes mellitus, a blood glucose of 420 mg/dL, and a foot ulcer. Which statement, if made by the nurse, is appropriate when giving feedback to this patient? A. "I am going to tell you what you are doing wrong because I know about diabetes." B. "You have this foot ulcer because you did not follow your diet and exercise plan." C. "From my perspective, the foot ulcer occurred because your blood sugars are high." D. "I know you don't want to hear this, but uncontrolled diabetes leads to complications."

ANS: C The nurse gives feedback respectfully if phrases such as "From my perspective ..." are used; the nurse uses the first person to convey thoughts and feelings, which prevents accusing or labeling the patient's behavior. The nurse should not give feedback to display superior knowledge or to rigidly control the behavior of a patient. The nurse should gain permission from the patient to give feedback. The nurse should not give feedback that is general—feedback should focus on specific, observable behavior.

The nurse cares for a patient who is admitted to the medical unit. The patient has type 2 diabetes mellitus, a blood glucose of 420 mg/dL, and a foot ulcer. Which statement, if made by the nurse, is appropriate when giving feedback to this patient? a. "I am going to tell you what you are doing wrong because I know about diabetes." b. "You have this foot ulcer because you did not follow your diet and exercise plan." c. "From my perspective, the foot ulcer occurred because your blood sugars are high." d. "I know you don't want to hear this, but uncontrolled diabetes leads to complications."

ANS: B Empathy is feeling with a deep understanding and awareness of the client's experiences. The nurse should develop a nonjudgmental attitude. Evaluation of feelings does not convey understanding or empathy. Sympathy focuses on the nurse and not the patient's feelings.

The nurse cares for a patient with a terminal illness. Which way would be the most therapeutic for the nurse to communicate with this patient? A. Use an honest, judgmental attitude. B. Demonstrate understanding with empathy. C. Acknowledge hope by expressions of sympathy. D. Consistently evaluate the patient's feelings.

ANS: D A Web-based service is available for the nurse to create an electronic portfolio, holding word processing-type data and scanned copies of your college diplomas, awards, certificates, professional presentations, etc. The nurse can give access to the electronic portfolio to potential employers. Client information (e.g., video of procedure, electronic medical record charting, and social networking support group) is confidential, and sharing confidential information is a Health Insurance Portability and Accountability Act (HIPAA) violation.

The nurse is preparing an electronic professional portfolio to provide to potential employers. The nurse determines that which is appropriate to include in the portfolio? a. A video recording on YouTube of the nurse performing a procedure on a client b. A sample of actual charting from clients' electronic medical records c. Access to a social networking site established by the nurse for a client support group d. Electronic resume with scanned copies of awards, certificates, and diplomas

ANS: B The following are recommendations for the sharing of self in a geriatric practice: 1) Self-disclosure helps the client get to know the nurse without the burden of high levels of intimacy; 2) Reminiscence is enhanced in elders when they are encouraged to share specific events (e.g., speak of personal holiday traditions and question clients about theirs); 3) Understand that the connection between nurse and patient is dynamic, and the perception of the nurse as a real person aids in establishing the helping relationship; 4) The nurse's sharing of self may help decrease the client's anxiety and diminish the stress of illness and treatment.

The nurse cares for an elderly patient in a long-term care center. Which would be inappropriate for the nurse to share with the client? A. Reminisce about birthday celebrations and inquire about the client's traditions. B. Use high levels of intimacy to help the client feel more comfortable with the nurse. C. Establish a helping relationship based on trust by sharing a personal story with the client. D. Share with the client how meditation decreased nausea during chemotherapy treatment.

ANS: C The initial action that the nurse should take to learn about delivering care to diverse clients is to become familiar with personal health care beliefs and behaviors. Self-awareness helps nurses recognize that their beliefs and behaviors are not necessarily common to all. Nurses' lack of knowledge about their own culture can distort their perceptions of the beliefs and behaviors of clients from diverse cultures. Transcultural frameworks have been developed to help nurses provide culturally appropriate nursing care. Ethnocentrism interferes with the appreciation of diverse cultures and their health care beliefs and behaviors.

The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about delivering care to diverse clients? A. Adopt a transcultural framework to develop culturally appropriate care. B. Ask clients about their personal health care beliefs. C. Develop a self-awareness of personal health care beliefs. D. Recognize ethnocentric beliefs of minorities in the community.

ANS: C The initial action that the nurse should take to learn about delivering care to diverse clients is to become familiar with personal healthcare beliefs and behaviors. Self-awareness helps nurses recognize that their beliefs and behaviors are not necessarily common to all. Nurses' lack of knowledge about their own culture can distort their perceptions of the beliefs and behaviors of clients from diverse cultures. Transcultural frameworks have been developed to help nurses provide culturally appropriate nursing care. Ethnocentrism interferes with the appreciation of diverse cultures and their healthcare beliefs and behaviors.

The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about delivering care to diverse clients? a. Adopt a transcultural framework to develop culturally appropriate care. b. Ask clients about their personal healthcare beliefs. c. Develop a self-awareness of personal healthcare beliefs. d. Recognize ethnocentric beliefs of minorities in the community.

ANS: D The nurse conveys empathy by offering a verbal reflection that is accurate and specific but is delivered in the words of the nurse not the patient. Nonverbal features of empathy are just as important as verbal aspects. It is unrealistic for the nurse to expect to completely know and understand the mother's feelings. Empathy does not mean repeating verbatim what others have said; this method may lead to irritation and lessen understanding.

The nurse cares for the mother of a child who died in the emergency room as a result of an accidental poisoning. Which response by the nurse is appropriate? A. Place a greater emphasis on nonverbal aspects of empathy over verbal. B. Accurately reflect on the mother's feelings to convey understanding and concern. C. Repeat exact phrases stated by the mother to aid in expressions of grief. D. Reflect on the expressed feelings of the mother but with the nurse's own words.

ANS: B Health information on Web pages should be updated regularly; information on hypertension should be updated yearly or more often. A nurse practitioner has the credentials appropriate to write and review patient information on hypertension. Peer-reviewed journals are appropriate sources for information on hypertension. Patient information should be written between a fourth- and sixth-grade reading level.

The nurse evaluates a Web site for patients with hypertension. Which, if included on the Web site, would the nurse question? a. The Web site was written by a nurse practitioner. b. The last update to the Web site was 5 years ago. c. References are from peer-reviewed journals. d. The language is at the fifth-grade reading level.

ANS: A The nurse with high evaluation anxiety tends to place high emphasis on how he or she is doing in comparison to others. Nurses with low evaluation anxiety will not be concerned about how the examiner is evaluating their performance, will be focused on the task and not their performance, and will blame external factors if performance is poor.

The nurse evaluates care provided by a licensed practical/vocational nurse (LPN/LVN). The nurse determines that the LPN/LVN has high evaluation anxiety if which is observed? A. The LPN/LVN compares self-performance to how other nurses are performing. B. The LPN/LVN is not concerned about how the nurse is evaluating performance. C. The LPN/LVN focuses on the actual tasks rather than thinking about self-performance. D. The LPN/LVN blames external factors if performance is inadequate or poor.

ANS: A The nurse with high evaluation anxiety tends to place high emphasis on how he or she is doing in comparison to others. Nurses with low evaluation anxiety will not be concerned about how the examiner is evaluating their performance, will be focused on the task and not their performance, and will blame external factors if performance is poor.

The nurse evaluates care provided by a licensed practical/vocational nurse (LPN/LVN). The nurse determines that the LPN/LVN has high evaluation anxiety if which is observed? a. The LPN/LVN compares self-performance to how other nurses are performing. b. The LPN/LVN is not concerned about how the nurse is evaluating performance. c. The LPN/LVN focuses on the actual tasks rather than thinking about self-performance. d. The LPN/LVN blames external factors if performance is inadequate or poor.

ANS: B It is important to call the patient by the name he or she prefers. The nurse should ask a person how he or she prefers to be addressed because considerable cultural variation exists. Most Americans are comfortable with calling people by their first names. This is perceived by some, however, as a failure to show respect.

The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate? a. Use both first and last name with each encounter. b. Ask the patient how he prefers to be addressed. c. Call the patient by his first name. d. Address the patient by his last name.

ANS: A To be more prepared, the colleague should visualize the entire interaction, which includes prior to the interaction (or preparation time), the interaction (or direct encounter), and post interaction. By mentally going through the whole encounter, you will be much better prepared. The individual must be clear about what will be communicated and determine the desired outcome. Imagery is most effective when the person is relaxed, so the person should begin imagery with three deep breaths to facilitate relaxation. It is important to practice imagery because the person will be able to go through the steps quickly and effectively.

The nurse instructs a colleague about how imagery can build confidence when communicating with other healthcare providers. The nurse determines further teaching is necessary if the colleague makes which statement? a. "Visualizations are most effective if the focus is on preparation for the encounter." b. "Before visualization I will clearly determine the desired outcome." c. "It is important to take three or four deep breaths before using imagery." d. "If I practice imagery regularly, the technique will be more effective."

ANS: D The American Heart Association Web site is a private source of reliable health information for patients. The National Institutes of Health, the Centers for Disease Control and Prevention, and the National Institute on Aging are government Web sites.

The nurse instructs a patient with a chronic disease about locating health information on the Internet. Which Web site would the nurse recommend as a reliable source of information from a private source? a. National Institutes of Health (http://health.nih.gov/) b. Centers for Disease Control and Prevention (http://www.cdc.gov/) c. National Institute on Aging (http://www.nia.nih.gov/) d. American Heart Association (http://www.americanheart.org/)

ANS: C When communicating feelings clearly and specifically, the individual must choose the descriptor that exactly conveys the intended emotion. Adding a rationale for the feeling enhances the sincerity of the message. If the emotion is one of feeling upset, the term "disappointed" is clear and specific. The descriptor "not dissatisfied" is the opposite of the feeling of "upset." The descriptor "angry" is a much stronger feeling than "upset." The statement "you must have misunderstood" does not convey the nurse's feelings about the situation.

The nurse instructs the nursing assistant to obtain temperatures on four patients and report abnormal findings immediately. Two hours later the nurse discovers that one of the patients had a fever that was not reported. The nurse is upset with the nursing assistant. Which statement, if made by the nurse, is concrete and specifically explains the nurse's feelings? A. "I am not dissatisfied with your performance, because we all make mistakes." B. "You must have misunderstood. I wanted to know about any elevated temperatures." C. "I am disappointed because you did not follow my directions." D. "You have made me so angry. Why did you not report the fever to me?"

ANS: C When communicating feelings clearly and specifically, the individual must choose the descriptor that exactly conveys the intended emotion. Adding a rationale for the feeling enhances the sincerity of the message. If the emotion is one of feeling upset, the term "disappointed" is clear and specific. The descriptor "not dissatisfied" is the opposite of the feeling of "upset." The descriptor "angry" is a much stronger feeling than "upset." The statement "you must have misunderstood" does not convey the nurse's feelings about the situation.

The nurse instructs the nursing assistant to obtain temperatures on four patients and report abnormal findings immediately. Two hours later the nurse discovers that one of the patients had a fever that was not reported. The nurse is upset with the nursing assistant. Which statement, if made by the nurse, is concrete and specifically explains the nurse's feelings? a. "I am not dissatisfied with your performance, because we all make mistakes." b. "You must have misunderstood. I wanted to know about any elevated temperatures." c. "I am disappointed because you did not follow my directions." d. "You have made me so angry. Why did you not report the fever to me?"

ANS: A Giving specific positive feedback is another form of expressing opinions that can demonstrate an assertive communication style. Sharing positive opinions helps team members feel comfortable, share ideas, and promote creativity and teamwork.

The nurse is a member of a quality improvement project team to improve communication when a patient is transferred to another unit. Which statement by the nurse is appropriate to demonstrate positive regard for the team members? A. "We have done an excellent job." B. "We still have so much work to do." C. "Most of our suggestions did not work." D. "We won't win a prize for our work."

ANS: A Giving specific positive feedback is another form of expressing opinions that can demonstrate an assertive communication style. Sharing positive opinions helps team members feel comfortable, share ideas, and promote creativity and teamwork.

The nurse is a member of a quality improvement project team to improve communication when a patient is transferred to another unit. Which statement by the nurse is appropriate to demonstrate positive regard for the team members? a. "We have done an excellent job." b. "We still have so much work to do." c. "Most of our suggestions did not work." d. "We won't win a prize for our work."

ANS: C, B, A, D The nurse should give assertive feedback when there is a difficult situation with a nursing assistant. The nurse should follow this formula to give assertive feedback: 1) When you ... (describe the behavior without judging it); 2) The effects are ... (describe concretely how it affects the individual's life in a practical sense); 3) I feel ... (describe feelings without blaming; the "I" statement implies ownership of feelings); and 4) I prefer ... (describe what response or change is desired, or, if possible, give the other person a chance to come up with a solution).

The nurse is concerned about a nursing assistant who does not immediately report vital signs that are out of normal range. Arrange the nurse's statements below in the correct order to give assertive feedback to the nursing assistant. A. "I would prefer that you notify me immediately if vital signs are abnormal." B. "The patients with abnormal vital signs are not evaluated in a timely manner." C. "When you take vital signs, you do not report abnormal values to me immediately." D. "I feel uncomfortable because the patients are not receiving safe nursing care."

ANS: B Eye contact is often cultural; some Native Americans believe that prolonged eye contact is rude and intrusive. However, it is important to assess each individual patient for preferences and comfort with eye contact.

The nurse is interviewing a Native American client. It is most important for the nurse to take which action? a. Maintain eye contact to show respect and interest. b. Assess whether the client is comfortable with eye contact. c. Avoid prolonged eye contact with this client. d. Sit next to the patient to avoid any eye contact.

ANS: B, C, E, F The Faith and Belief: Importance, Community, and Address in Care (FICA) tool suggests appropriate questions for taking a spiritual history (see Box 16-1). The nurse may assume the role of spiritual guide to extend love, compassion, and empathy but not to become the patient's spiritual counselor. It is usually best to refrain from using "why" to ask questions because patients may feel threatened; it is better to rephrase the question so it is softer and more receivable.

The nurse is taking a spiritual history from a patient with a terminal illness. Using the FICA tool, which question(s), if asked by the nurse, would be appropriate? (Select all that apply) a. "Would you like me to serve as your spiritual counselor?" b. "What gives your life meaning?" c. "What importance does your faith have for you? d. "Why do you think your spirituality has not saved you?" e. "Are you part of a religious community?" f. "How can I help you address your spiritual needs?"

ANS: B, C, E, F The Faith and Belief: Importance, Community, and Address in Care (FICA) tool suggests appropriate questions for taking a spiritual history (see Box 16-1). The nurse may assume the role of spiritual guide to extend love, compassion, and empathy but not to become the patient's spiritual counselor. It is usually best to refrain from using "why" to ask questions because patients may feel threatened; it is better to rephrase the question so it is softer and more receivable.

The nurse is taking a spiritual history from a patient with a terminal illness. Which question(s), if asked by the nurse, would be appropriate? Select all that apply. A. "Would you like me to serve as your spiritual counselor?" B. "What gives your life meaning?" C. "What importance does your faith have for you? D. "Why do you think your spirituality has not saved you?" E. "Are you part of a religious community?" F. "How can I help you address your spiritual needs?"

ANS: D An effective and efficient way to locate current literature is by electronic searches; Google Scholar is appropriate for the nurse to locate scholarly journal articles. Similar policies from other hospitals are not equivalent to a review of current literature. Review of a journal's table of contents is not an efficient method to locate current literature. Consultation with a librarian is appropriate; the librarian will suggest electronic searches such as Google Scholar, CINAHL, or PubMed.

The nurse is updating a patient care policy based on current literature. Which action by the nurse is best? a. Search online for similar policies from other hospitals. b. Review the table of contents of several current journals. c. Ask the librarian at the public library for assistance. d. Use Google Scholar to locate appropriate journal articles.

ANS: A, B, E A mentor in nursing represents excellence in knowledge, skill, and competence; affective components are warmth, acceptance, friendliness, empathy, compassion, patience, a willingness to learn and share, and generosity. Mentors have a positive outlook, are loyal and nurturing, enjoy nursing, and have superior communication skills. A nurse with an advanced degree or with certification in a specialty area will not necessarily have the characteristics of a good mentor.

The nurse manager decides to initiate a mentoring program for new graduate nurses on a medical unit. The nurse manager should consider asking which nurse(s) to serve as mentors? Select all that apply. A. A nurse who excels in nursing knowledge and skills and has a positive attitude. B. A nurse who has excellent communication skills and a positive outlook. C. A nurse who is certified in psychiatric care and works in a mental health setting. D. A nurse who excels as a manager and has an advanced degree in administration. E. A nurse who is warm, empathetic, and has a passion for nursing and helping others.

ANS: A, B, E A mentor in nursing represents excellence in knowledge, skill, and competence; affective components are warmth, acceptance, friendliness, empathy, compassion, patience, a willingness to learn and share, and generosity. Mentors have a positive outlook, are loyal and nurturing, enjoy nursing, and have superior communication skills. A nurse with an advanced degree or with certification in a specialty area will not necessarily have the characteristics of a good mentor.

The nurse manager decides to initiate a mentoring program for new graduate nurses on a medical unit. The nurse manager should consider asking which of the following three nurses to serve as mentors? (Select all that apply) a. A nurse who excels in nursing knowledge and skills and has a positive attitude. b. A nurse who has excellent communication skills and a positive outlook. c. A nurse who is certified in psychiatric care and works in a mental health setting. d. A nurse who excels as a manager and has an advanced degree in administration. e. A nurse who is warm, empathetic, and has a passion for nursing and helping others.

ANS: A A 360-degree feedback, or multisource performance approval data, is used as a staff development tool because feedback is drawn from peers and subordinates to supplement direct observation by the manager.

The nurse manager of a critical care unit initiates a 360-degree feedback as a tool to aid in the development of the staff nurses. Who will provide feedback on each nurse's performance? a. Nurse manager, other staff nurses, and nursing assistants b. Patients, family members, and hospital volunteers c. Physicians, respiratory therapists, and other specialists d. Chief executive officer, nursing director, and nurse manager

ANS: A Three-hundred-and-sixty-degree feedback, or multisource performance approval data, is used as a staff development tool because feedback is drawn from peers and subordinates to supplement direct observation by the manager.

The nurse manager of a critical care unit initiates three-hundred-and-sixty degree feedback as a tool to aid in the development of the staff nurses. Who will provide feedback on each nurse's performance? A. Nurse manager, other staff nurses, and nursing assistants B. Patients, family members, and hospital volunteers C. Physicians, respiratory therapists, and other specialists D. Chief executive officer, nursing director, and nurse manager

ANS: A The nurse manager may request a receipt from the staff nurses when the e-mail has been opened and read. Messages should not be typed in uppercase letters because this may be perceived as shouting. SMS language is used with text messages and is shortened versions of normal words with abbreviations and representations of particular words with certain patterns. The subject line should be used to identify the content of the e-mail.

The nurse manager plans to send an e-mail to staff nurses about a new policy. It is most important for the nurse manager to take which action? a. Request a receipt of the message. b. Type the message in uppercase letters. c. Use SMS language to write the message. d. Leave the subject line of the message blank.

ANS: C Professional interpreters are able to communicate medical terms and can be of assistance in reducing the risks of breaches in patient privacy and confidentiality. Also, information can be directly obtained from the patient. When family members or volunteers serve as the interpreter, patients are often uncomfortable sharing sensitive information. Family members in a stressful situation may have difficulty being the interpreter. Although nonverbal communication is important, this method should only be used if an interpreter is not available.

The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best? A. Ask a bilingual friend of the patient to interpret. B. Use nonverbal communication and draw pictures. C. Request a Spanish-speaking medical interpreter. D. Interview the patient's English-speaking daughter.

ANS: C Professional interpreters are able to communicate medical terms and can be of assistance in reducing the risks of breaches in patient privacy and confidentiality. Also, information can be directly obtained from the patient. When family members or volunteers serve as the interpreter, patients are often uncomfortable sharing sensitive information. Family members in a stressful situation may have difficulty being the interpreter. Although nonverbal communication is important, this method should only be used if an interpreter is not available.

The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best? a. Ask a bilingual friend of the patient to interpret. b. Use nonverbal communication and draw pictures. c. Request a Spanish-speaking medical interpreter. d. Interview the patient's English-speaking daughter.

ANS: D The elderly should not be addressed using disrespectful terms such as "honey," "sweetheart," "gramps," and "granny" and other patronizing forms of speech. Short term memory may decline with age; health care providers may assist patients as needed. The elderly may express their spirituality through prayer and reading the Bible. Sharing stories helps an elderly patient to review life and establish meaning.

The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse? A. "I will help you remember where your room is located." B. "Would you like me to read from your Bible today?" C. "Tell me a story about when you were young." D. "Sweetie, I will bring your coffee in a few minutes."

ANS: D The elderly should not be addressed using disrespectful terms such as "honey," "sweetheart," "gramps," and "granny" and other patronizing forms of speech. Short-term memory may decline with age; healthcare providers may assist patients as needed. The elderly may express their spirituality through prayer and reading the Bible. Sharing stories helps an elderly patient to review life and establish meaning.

The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse? a. "I will help you remember where your room is located." b. "Would you like me to read from your Bible today?" c. "Tell me a story about when you were young." d. "Sweetie, I will bring your coffee in a few minutes."

ANS: D The nurse can use imagery when performing procedures. Imagery as an alternative language is truthful but suggests a different sensation than anticipated. When removing a urinary catheter, the nurse would describe the sensation as "burning" instead of as "painful" or "really hurts." This language decreases anxiety and shifts the pattern from response to "pain" to response to "burning." The nurse should convey sensations that are truthful; the nurse should avoid statements such as "You will not feel anything."

The nurse plans to use imagery as an alternative language when removing a urinary catheter. Which statement, if made by the nurse, would be most appropriate? a. "Removing a catheter really hurts." b. "You will not feel anything." c. "It will be briefly painful." d. "You may feel a burning sensation."

ANS: B, C, A, D The steps to successfully implement helpful self-disclosure are: 1) Actively listen to the parents' verbal and nonverbal messages; 2) Reply with an empathic response; 3) Self-disclose for the benefit of the parents; and 4) Check to see if the empathic response and self-disclosure were effective.

The nurse plans to use self-disclosure to aid a mother and father in the grieving process after the death of their child. The steps of a helpful self-disclosure appear below. Arrange the steps in the correct order of use. A. Succinctly share a personal experience that is a similar grieving experience. B. Listen to the parents talk about their child and observe their movements and gestures. C. Reflect upon the parent's statements to communicate understanding. D. Seek verification that the self-disclosure was helpful to the child's parents.

ANS: A The nurse can encourage a positive attitude by asking patients appropriate questions such as: 1) "What brings joy to your life?" 2) "What do you do for fun?" or 3) "What is going well for you today?" Asking a patient about being upset, concerns, or stress does not focus on generating a positive attitude.

The nurse prepares to administer the first chemotherapy treatment to a patient. Which statement by the nurse encourages a positive attitude? A. "What brings joy to your life?" B. "Will you be upset if you lose your hair?" C. "What are your concerns about your treatment?" D. "How do you usually cope with stress?"

ANS: A The nurse can encourage a positive attitude by asking patients appropriate questions such as (1) "What brings joy to your life?" (2) "What do you do for fun?" or (3) "What is going well for you today?" Asking a patient about being upset, concerns, or stress does not focus on generating a positive attitude.

The nurse prepares to administer the first chemotherapy treatment to a patient. Which statement by the nurse encourages a positive attitude? a. "What brings joy to your life?" b. "Will you be upset if you lose your hair?" c. "What are your concerns about your treatment?" d. "How do you usually cope with stress?"

ANS: B It is important to call the patient by the name he or she prefers. The nurse should ask a person how he or she prefers to be addressed, because considerable cultural variation exists. Most Americans are comfortable with calling people by their first names. This is perceived by some, however, as a failure to show respect.

The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate? A. Use both first and last name with each encounter. B. Ask the patient how he prefers to be addressed. C. Call the patient by his first name. D. Address the patient by his last name.

ANS: B Tripp-Reimer and Afifi (1989) suggest two processes that nurses may use to communicate with clients from diverse cultures: cultural assessment and cultural negotiation. Cultural assessment refers to the appraisal of a client's health beliefs and behaviors. The information is then used to determine appropriate nursing interventions. Cultural negotiation refers to the process of negotiating with the client regarding differences in the lay and professional belief systems concerning appropriate care. Information obtained from other sources (e.g., written documents, other nurses, experts, standards) is not specific to this client's health beliefs and behaviors.

The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client? A. Review the predominant health beliefs of the Nigerian population. B. Appraise the client's health beliefs and behaviors with a cultural assessment. C. Consult with other nurses who have taken care of clients from other countries. D. Use standard communication techniques to establish a helping relationship.

ANS: B Tripp-Reimer and Afifi (1989) suggest two processes that nurses may use to communicate with clients from diverse cultures: cultural assessment and cultural negotiation. Cultural assessment refers to the appraisal of a client's health beliefs and behaviors. The information is then used to determine appropriate nursing interventions. Cultural negotiation refers to the process of negotiating with the client regarding differences in the lay and professional belief systems concerning appropriate care. Information obtained from other sources (e.g., written documents, other nurses, experts, and standards) is not specific to this client's health beliefs and behaviors.

The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client? a. Review the predominant health beliefs of the Nigerian population. b. Appraise the client's health beliefs and behaviors with a cultural assessment. c. Consult with other nurses who have taken care of clients from other countries. d. Use standard communication techniques to establish a helping relationship.

ANS: B Nurses must nurture their own spirit before being able to stay connected to the experience of a patient. Practicing techniques (e.g., relaxation techniques, meditation, time in nature, yoga, music) helps nurses to be in touch with their own spirituality and with becoming centered. It is only then that nurses are effective in spiritual assessments, being present, and identifying resources.

The nurse provides spiritual care for hospice patients. Which action by the nurse should be completed first? A. Perform spiritual assessments with hospice patients. B. Practice techniques to enrich spirituality and centeredness. C. Determine available resources in the community. D. Practice the art of presence with the patients.

ANS: B Nurses must nurture their own spirit before being able to stay connected to the experience of a patient because it helps them to be in touch with their own spirituality and with becoming centered. It is only then that nurses are effective in spiritual assessments, being present, and identifying resources.

The nurse provides spiritual care for hospice patients. Which action by the nurse should be completed first? a. Perform spiritual assessments with hospice patients. b. Practice techniques to enrich your personal spirituality and centeredness. c. Determine available resources in the community. d. Practice the art of presence with the patients.

ANS: C Open questions (e.g., "What do you know about hypertension?") invite respondents to elaborate in whatever direction they choose. Closed questions are focused and posed to elicit specific and brief responses from clients. Questions (e.g., "Are you taking any blood pressure medications?" or "Do you understand why salt is bad for you?") that only require a "yes" or "no" do not invite the patient to elaborate further about the experience. Questions that require a short answer (e.g., "How long have you had hypertension?") do not provide an opportunity for the patient to elaborate further about hypertension.

The nurse questions a patient with hypertension before developing a teaching plan. Which question, if asked by the nurse, is most appropriate? A. "How long have you had hypertension?" B. "Are you taking any blood pressure medications?" C. "What do you know about hypertension?" D. "Do you understand why salt is bad for you?"

ANS: C Open questions (e.g., "What do you know about hypertension?") invite respondents to elaborate in whatever direction they choose. Closed questions are focused and posed to elicit specific and brief responses from clients. Questions (e.g., "Are you taking any blood pressure medications?" or "Do you understand why salt is bad for you?") that only require a "yes" or "no" do not invite the patient to elaborate further about the experience. Questions that require a short answer (e.g., "How long have you had hypertension?") do not provide an opportunity for the patient to elaborate further about hypertension.

The nurse questions a patient with hypertension before developing a teaching plan. Which question, if asked by the nurse, is most appropriate? a. "How long have you had hypertension?" b. "Are you taking any blood pressure medications?" c. "What do you know about hypertension?" d. "Do you understand why salt is bad for you?"

ANS: C The nurse should seek more information from the person who is giving the criticism by asking for specific facts about the particular behavior; this information helps to determine the validity of the criticism. The nurse should be assertive and reply to unjust or aggressive criticism; the nurse should not let it pass without speaking up. Reply to criticism with civility; incivility, rude or discourteous behavior violates the desired climate of mutual respect. If the nurse receives criticism more than once, the nurse should take note of it; there is likely some truth to criticism heard repeatedly.

The nurse receives criticism during a performance evaluation by a nursing supervisor. Which response by the nurse is most appropriate? A. Disregard criticism that is given on more than one evaluation. B. Reply with incivility if the criticism is destructive or disrespectful. C. Ask for specific details or examples of the behavior being criticized. D. Avoid confrontation if the evaluator gives unfair criticism.

ANS: E To have the ability to stay connected to the experience of another, you must pay attention to nurturing your own spirit. Moore (1998) and others speak of living artfully as a necessity for the care of the soul or spirit. To take pause, take time for self, be mindful, focus on moment, practice spiritual self care, practice gratitude, or even keep a journal are all recommended to help nurses get in touch with themselves.

Throughout this chapter, many recommendations were given on how to first nurture yourself so you could be fully present with your patients. Which one of the following would not help you accomplish that goal? a. Gratefulness reflection b. Completing a self-spiritual assessment c. Utilizing the FICA acronym with your patients d. Journaling e. Ignoring your own spirituality f. Participating in the "Blessing of the Hands"

ANS: C The nurse should seek more information from the person who is giving the criticism by asking for specific facts about the particular behavior; this information helps to determine the validity of the criticism. The nurse should be assertive and reply to unjust or aggressive criticism; the nurse should not let it pass without speaking up. Reply to criticism with civility; incivility, rude, or discourteous behavior violates the desired climate of mutual respect. If the nurse receives criticism more than once, the nurse should take note of it; there is likely some truth to criticism heard repeatedly.

The nurse receives criticism during a performance evaluation by a nursing supervisor. Which response by the nurse is most appropriate? a. Disregard criticism that is given on more than one evaluation. b. Reply with incivility if the criticism is destructive or disrespectful. c. Ask for specific details or examples of the behavior being criticized. d. Avoid confrontation if the evaluator gives unfair criticism.

ANS: C Use encouraging or questioning sounds or body language as cues to encourage the patient to continue talking. Try "Oh ... ?" when you sense that the client has more to say and then be quiet. Avoid the question "How does that make you feel?" which may make patients believe they are being analyzed. Refrain from using "why" because doing so tends to make patients feel threatened. It is better to rephrase the question so it is softer and more receivable. The nurse should not indicate that the patient may be lying or withholding information.

The nurse senses the patient has more to say and wants to encourage the patient to continue talking. It is most appropriate for the nurse to state: A. "I think you may not be telling me everything." B. "How does that make you feel?" C. "Oh .... ?" and wait for the patient to continue. D. "Why do you feel that way?"

ANS: C Use encouraging or questioning sounds or body language as cues to encourage the patient to continue talking. Try "Oh ... ?" when you sense that the client has more to say and then be quiet. Avoid the question "How does that make you feel?" which may make patients believe they are being analyzed. Refrain from using "why" because doing so tends to make patients feel threatened. It is better to rephrase the question so it is softer and more receivable. The nurse should not indicate that the patient may be lying or withholding information.

The nurse senses the patient has more to say and wants to encourage the patient to continue talking. It is most appropriate for the nurse to state: a. "I think you may not be telling me everything." b. "How does that make you feel?" c. "Oh ... ?" and wait for the patient to continue. d. "Why do you feel that way?"

ANS: D Affirmations are positive self-talk statements. "I feel great today" is in the present tense, optimistic, short, and specific. The other statements are negative, destructive, and pessimistic.

The nurse suggests that patients use affirmations to develop a sense of well-being and health. Which affirmation would be appropriate for the nurse to recommend to this patient? A. I am too sensitive about my weight. B. I must exercise every day. C. I will not eat processed foods. D. I feel great today.

ANS: D Affirmations are positive self-talk statements. "I feel great today" is in the present tense, optimistic, short, and specific. The other statements are negative, destructive, and pessimistic.

The nurse suggests that patients use affirmations to develop a sense of well-being and health. Which affirmation would be appropriate for the nurse to recommend to this patient? a. I am too sensitive about my weight. b. I must exercise every day. c. I will not eat processed foods. d. I feel great today.

ANS: A Relaxation strategies (e.g., meditation) work best when a person is not totally depleted. To make the best use of relaxation skills, self-care needs should be met. Self-care should include eating nutritious foods, taking breaks while at work, dealing with emotions (e.g., with fear, frustration, hurt) that lead to anger, nurturing relationships with others, and getting eight hours of sleep.

The nurse supervises a nursing assistant who reports feeling stress and not being able to relax. When talking with the nursing assistant, which statement by the nurse is best? A. "I suggest meditation, but meditation works better if you eat a healthy diet." B. "Relaxation strategies do not work until you learn to control negative emotions." C. "All you need to do to relieve stress is take short breaks and get eight hours of sleep." D. "You will be more relaxed if you stop wasting time being with close friends."

ANS: A Relaxation strategies (e.g., meditation) work best when a person is not totally depleted. To make the best use of relaxation skills, self-care needs should be met. Self care should include eating nutritious foods, taking breaks while at work, dealing with emotions (e.g., with fear, frustration, and hurt) that lead to anger, nurturing relationships with others, and getting 8 hours of sleep

The nurse supervises a nursing assistant who reports feeling stress and not being able to relax. When talking with the nursing assistant, which statement by the nurse is best? a. "I suggest meditation, but meditation works better if you eat a healthy diet." b. "Relaxation strategies do not work until you learn to control negative emotions." c. "All you need to do to relieve stress is take short breaks and get 8 hours of sleep." d. "You will be more relaxed if you stop wasting time being with close friends."

ANS: D Medical humor that is used by health care providers to cope is appropriate when kept among staff because it permits sharing of frustration and promotes group cohesion; this type of humor is negative if used with clients (e.g., other residents) and is demeaning and inappropriate. If demeaning humor is used, an assertive response is to remain quiet. It is appropriate for a health care worker to share positive humor (e.g., laugh while watching a television show) with clients. The highest form of positive humor is the ability to laugh at ourselves.

The nurse supervises the care of residents in an assisted living center. The nurse should intervene if which is observed? A. A nursing assistant remains silent when a resident tells a demeaning joke. B. A nursing assistant and resident laugh together while watching television. C. Two nursing assistants laugh at themselves after spilling a pitcher of water. D. A nursing assistant makes a joke about a confused resident to other residents.

ANS: D Medical humor that is used by healthcare providers to cope is appropriate when kept among staff because it permits sharing of frustration and promotes group cohesion; this type of humor is negative if used with clients (e.g., other residents) and is demeaning and inappropriate. If demeaning humor is used, an assertive response is to remain quiet. It is appropriate for a healthcare worker to share positive humor (e.g., laugh while watching a television show) with clients. The highest form of positive humor is the ability to laugh at ourselves.

The nurse supervises the care of residents in an assisted living center. The nurse should intervene if which is observed? a. A nursing assistant remains silent when a resident tells a demeaning joke. b. A nursing assistant and resident laugh together while watching television. c. Two nursing assistants laugh at themselves after spilling a pitcher of water. d. A nursing assistant makes a joke about a confused resident to other residents.

ANS: D Muscle stretches augment the benefits of meditation and on-the-spot exercises; relaxation strategies are equally effective in reducing stress. Relaxation techniques can change feelings of tightness and fear to relaxation and a feeling of competence and create inner self-confidence. Imagery (e.g., of massage) can help a person cope with an unexpected stressful interpersonal encounter. Abdominal breathing is an on-the-spot method for relaxing the body.

The nurse teaches a client about relaxation techniques that can be used to reduce situational stress. Which statement by the client requires an intervention from the nurse? A. "Relaxation techniques can give me self-confidence and a feeling of competence." B. "If an angry person is going to talk to me, I can imagine myself getting a massage." C. "I should use abdominal breathing to help me relax in stressful situations." D. "Progressive stretching exercises are more effective than meditation to relieve stress."

ANS: C Self-disclosure is used to help the nurse understand the patient better; the goal is not to help the client understand the nurse better. Self-disclosure should be used only if the experience is similar and the experience actually happened.

The nursing supervisor instructs a group of novice nurses about the appropriate use of self-disclosure with patients. The nursing supervisor determines that teaching was successful if the novice nurse makes which statement? A. "Self-disclosure provides an opportunity for the patient to understand the nurse." B. "It is better to disclose stories about others to maintain professional boundaries." C. "Self-disclosure may be used to build a trusting relationship with the patient." D. "A fabricated personal experience can be shared if the patient remains the main focus."

ANS: C Electronic communication is used in healthcare to promote patient safety and effective quality care. Electronic communication does not guarantee safe, quality patient care. Electronic communication can be easily misunderstood because nonverbal cues are not available. Breach of confidentiality can occur with electronic communication.

The patient asks the nurse to explain why computers are needed in healthcare. Which response by the nurse is best? a. "Electronic communication by computer is rarely misunderstood." b. "Computers eliminate problems with protecting patient information." c. "The computer is used to promote safe and effective patient care." d. "Use of technology such as computers assures safe, quality patient care."

ANS: C The nurses should follow the steps for requesting cognitive support: (1) the first step is to identify their need for support; (2) the next step is to decide if they wish to pursue this support; (3) once they have decided to try to obtain the support, they must obtain information (e.g., literature review, survey ED nurses); (4) the next step is to design their strategy to present the information; and (5) the nurses should prepare for the presentation to the nurse manager.

Three emergency department (ED) nurses are interested in initiating a new policy related to family presence during cardiopulmonary resuscitation (CPR). The steps a nurse would utilize to request support for initiation of this policy are listed below. What is the first step? a. The nurses review literature and survey ED nurses about family presence during CPR. b. The nurses practice their presentation to the nurse manager. c. The nurses identify the need to gain support from the nurse manager for this policy. d. The nurses decide to approach the nurse manager with their idea. e. The nurses develop a specific strategy to present the information to the nurse manager.

ANS: C, D, A, E, B The nurses should follow the steps for requesting cognitive support: 1) The first step is to identify their need for support; 2) The next step is to decide if they wish to pursue this support; 3) Once they have decided to try to obtain the support, they must obtain information (e.g., literature review, survey ED nurses); 4) The next step is to design their strategy to present the information; and 5) The nurse should prepare for the presentation to the nurse manager.

Three emergency department (ED) nurses are interested in initiating a new policy related to family presence during cardiopulmonary resuscitation (CPR). The steps to request support for initiation of this policy are listed below. Arrange the steps in the correct order of use? A. The nurses review literature and survey ED nurses about family presence during CPR. B. The nurses practice their presentation to the nurse manager. C. The nurses identify the need to gain support from the nurse manager for this policy. D. The nurses decide to approach the nurse manager with their idea. E. The nurses develop a specific strategy to present the information to the nurse manager.

ANS: C Daily relaxation techniques (e.g., progressive relaxation, meditation) eliminate the negative build-up of stress and help nurses become more focused and alert, promoting safety for clients and for themselves. Stress is a result of unhealthy habits (e.g., eating processed foods, not taking breaks).

Which activity, if performed by the nurse, can improve patient safety? a. Pass up breaks to provide more time for patient care. b. Consume processed foods to increase energy level. c. Practice progressive relaxation exercises every day. d. Remain alert by not practicing meditation before work.

ANS: A, B, E, F Causes of stress in nursing include the following: (1) increased acuteness of clients' conditions; (2) shortage of personnel; (3) distressing and anxiety-provoking situations; (4) changing exposure to different personnel in a complex working environment; (5) insufficient resources; and (6) excessive workload.

Which are known causes of workplace stress for nurses? (Select all that apply) a. Increased acuity of patients b. Shortage of personnel c. Increase in available resources d. Reduced workload e. Distressing patient situations f. Communicating with colleagues

ANS: A, B, E, F Causes of stress in nursing include the following: 1) Increased acuteness of clients' conditions; 2) shortage of personnel; 3) distressing and anxiety-provoking situations; 4) changing exposure to different personnel in a complex working environment; 5) insufficient resources; and 6) excessive workload

Which are known causes of workplace stress for nurses? Select all that apply. A. Increased acuity of patients B. Shortage of personnel C. Increase in available resources D. Reduced workload E. Distressing patient situations F. Communicating with colleagues

ANS: B, D, E For those interpersonal situations in which the nurse feels uncomfortable, it is wise to repeat a positive visualization several times. After an interaction, the nurse should take time to evaluate how the session went. To augment confidence, it is wise to envision unexpected events that may be encountered and practice how to cope with them. Self-evaluation should focus on how imagery positively affected the interaction. The nurse should not focus on errors but rather on how imagery could be used for continued improvement in communication skills.

Which imagery techniques would improve a nurse's communication skills? (Select all that apply) a. Self-confidence will be improved if the nurse critically reviews communication errors. b. If the interaction will be stressful, the visualization should be practiced several times. c. Actual words and actions should be included in visualizations rather than feelings. d. The nurse should evaluate the effect of imagery on self-confidence after the interaction. e. Visualize coping with unexpected events that may occur during the interaction.

ANS: A Spiritual care begins with being fully present; nursing presence is a conscious act of being fully present in body, mind, emotions, and spirit with a patient. Being silent and use of therapeutic touch are examples of being present. Performing tasks or assessments (e.g., obtaining a health history, administering medications) are not examples of being fully present. Spiritual care is more than religion or visitation from a chaplain.

Which nurse is being fully present with the patient to provide spiritual care? a. The nurse sits quietly with a patient and uses therapeutic touch. b. The nurse gathers a complete health history from a patient. c. The nurse asks if the patient would like the chaplain to visit. d. The nurse reassures a patient while giving medications.

ANS: A, C, D To avoid generating feelings of hostility or resentment, the nurse should ask colleagues if they are interested in hearing the nurse's viewpoint. The nurse should avoid being dogmatic or using strong phrases when expressing opinions. The nurse should be tentative about offering persuasions to show consideration of others' special circumstances. When offering an opinion, the nurse should give others a fair chance to accept or reject ideas. When expressing opinions to colleagues, the nurse should give the rationale in a responsible way; the nurse should offer a reason for his or her preferences and then turn the final decision back to the client.

Which nurse statement(s) is/are examples of expressing opinions in an assertive way with colleagues? Select all that apply. A. "Do you think this project will help you learn about evidence-based practice?" B. "I will tell you about the evidence-based project, and you will want to help." C. "I recently attended an evidence-based conference. Can I share the highlights?" D. "I think we should be paid because this project will save money. What do you think?" E. "I really think you should read more evidence-based journal articles."

ANS: A Different cultures prefer different degrees of closeness in personal space. Optimal distance for a therapeutic conversation is usually 3 to 4 feet. Generally, middle-class Americans feel uncomfortable when standing close to people they do not know well. Latin Americans, African Americans, and the French welcome physical closeness. In most cultures, men need more space than women do. Usually people will tolerate a person standing close to them at their side more readily than directly in front of them. Direct eye contact usually requires more space. Placing oneself at the same level (e.g., sitting while the client is sitting or standing at eye level when the client is standing) is usually perceived as less threatening. Nurses should sit at eye level with bedridden clients.

Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse? a. A 19-year-old white female patient who is standing 2 feet in front of the nurse. b. A 40-year-old African-American male patient who is sitting next to the nurse. c. A 60-year-old Latin-American female patient who is seated across from the nurse. d. An 82-year-old patient from France who is lying in bed with the nurse sitting next to the bed.

ANS: A Different cultures prefer different degrees of closeness in personal space. Optimal distance for a therapeutic conversation is usually 3 to 4 feet. Generally, middle-class Americans feel uncomfortable when standing close to people they do not know well. Latin Americans, African Americans, and the French welcome physical closeness. In most cultures, men need more space than women do. Usually people will tolerate a person standing close to them at their side more readily than directly in front of them. Direct eye contact usually requires more space. Placing oneself at the same level (e.g., sitting while the client is sitting, or standing at eye level when the client is standing) is usually perceived as less threatening. Nurses should sit at eye level with bedridden clients.

Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse? A. 19-year-old white female patient who is standing two feet in front of the nurse. B. 40-year-old African-American male patient who is sitting next to the nurse. C. 60-year-old Latin-American female patient who is seated across from the nurse. D. 82-year-old patient from France who is lying in bed with the nurse sitting next to the bed.

ANS: C Positive self-talk is important in situations that are known to be difficult for nurses to communicate assertively and responsibly. These situations include: 1) When clients or colleagues are distressed; 2) When clients or colleagues are aggressive; 3) When there is team conflict; 4) When evaluation anxiety is experienced; and 5) When unpopular clients are encountered.

Which situation may be difficult for the nurse to communicate assertively and responsibly if self-talk is negative? A. A colleague provides constructive criticism on how the nurse gives report. B. An interdisciplinary team compromises on a patient care issue. C. A patient is angry because pain has not been adequately controlled. D. A supervisor gives the nurse a superior rating on an annual review.

ANS: C Positive self-talk is important in situations that are known to be difficult for nurses to communicate assertively and responsibly. These situations include (1) when clients or colleagues are distressed; (2) when clients or colleagues are aggressive; (3) when there is team conflict; (4) when evaluation anxiety is experienced; and (5) when unpopular clients are encountered.

Which situation may be difficult for the nurse to communicate assertively and responsibly if self-talk is negative? a. A colleague provides constructive criticism on how the nurse gives report. b. An interdisciplinary team compromises on a patient care issue. c. A patient is angry because pain has not been adequately controlled. d. A supervisor gives the nurse a superior rating on an annual review.

ANS: B, D, E It is appropriate to communicate with empathy when clients or colleagues are hurting, confused, troubled, anxious, alienated, terrified, doubtful of self-worth, or uncertain as to identity. The nurse should be cautious if the relationship involves a person in power such as an employer or superficial or romantic relationships.

Which situation(s) would be appropriate for the nurse to communicate with empathy? Select all that apply. A. An acquaintance who seeks a long-standing social relationship that is superficial. B. A patient who is anxious about a change in body image after a mastectomy. C. A supervisor who is searching for approval and recognition from staff. D. A colleague who expected a promotion but was not awarded the promotion. E. A client who has been alienated from family because of sexual orientation.

ANS: A The placebo effect is language or expectations of a nurse that positively affect the course of the patient's illness by suggestibility. Breastfeeding does take more time, but the nurse can send a positive message (e.g., increased time for bonding). The nocebo effect can occur when a nurse sends a negative message through choice of language, words, or tone of voice that produces negative responses (e.g., breast feeding takes time, limits medication options, and causes infections).

Which statement, if made by the nurse, could positively affect the course of the patient's illness by suggestibility? A. "Breastfeeding will provide time to bond with your baby." B. "Breastfeeding will take longer than giving your baby a bottle." C. "You will need to be careful about taking medications while breastfeeding." D. "Breastfeeding mothers can develop infections that are serious."

ANS: A The placebo effect is language or expectations of a nurse that positively affect the course of the patient's illness by suggestibility, and the nurse is sending a positive message (e.g., increased time for bonding). When considering bottle preparation, storage, and cleanup, it is inaccurate to say that breastfeeding will take more time. The nocebo effect can occur when a nurse sends a negative message through choice of language, words, or tone of voice that produces negative responses (e.g., breastfeeding takes time, limits medication options, and causes infections).

Which statement, if made by the nurse, could positively affect the course of the patient's situation by suggestibility? a. "Breastfeeding will provide time to bond with your baby." b. "Breastfeeding will take longer than giving your baby a bottle." c. "You will need to be careful about taking medications while breastfeeding." d. "Breastfeeding mothers can develop infections that are serious."

ANS: B, C, E The nurse should provide a concise statement as a rationale for questioning. If the nurse offers the patient options, the nurse should allow the patient time to speak and make a decision without interruptions. The nurse should not ask a string of questions because the patient may become confused and not know what information is important or where to begin answering. The nurse should not use medical terminology, abbreviations, or medical jargon that the patient does not understand. When asking the patient questions, the nurse should refrain from using "why" by rephrasing the question so it is softer and more receivable.

Which technique(s) should be avoided when the nurse questions patients? Select all that apply. A. Use questions that are worded clearly with words the patient understands. B. Provide a detailed explanation to introduce the rationale for the questions. C. Offer the patient options and tell the patient which option is preferred. D. Avoid asking a patient "why" by rephrasing the question if possible. E. Ask three to five questions at a time and then allow the patient to answer.

ANS: B Relaxation skills, a mainstay in complementary medicine in recent years, are tools for effective stress management that are a part of a proactive approach to taking responsibility for coming to your work strong and feeling emotionally and physically well (Lee and Yeo, 2013). Resilience is the ability to adjust to change, to "bounce back." Relaxation strategies work best when you are not totally depleted. HALT is an acronym for Hungry, Angry, Lonely, and Tired, introduced in Alcoholics Anonymous, to remind us of vulnerabilities that make us less resilient (Friedmann et al., 2003). Being available mentally and emotionally would actually increase your ability to relax.

While nursing students are preparing for a major test, the instructor reminds them to take short breaks while studying to relax. The instructor also reminds them that one of the main blockades to relaxation related to a lack of self care can be symbolized by the acronym HALT. The nursing student writes down four words starting with those letters, but feels one is incorrect. As a fellow nursing student, you help your peer to understand which one of the following is not a part of the HALT acronym? a. Hungry b. Available c. Lonely d. Tired

ANS: D While certified, understanding, and exceptional care means a lot to their patients, this particular author referred to a study by Serra (2012) where patients receiving radiation for breast cancer shifted from feelings of fear to a sense of strength and calmness after nurse-guided imagery sessions.

With cancer patients, sometimes the implementation process involves a broader scope than nurses might utilize in different areas of healthcare. The author described some breast cancer patients as being able to shift "from feelings of fear to a sense of strength and calmness." In this instance, this was a result of a. Care provided by certified nurses b. Understanding care c. Exceptional care d. Nurse-guided imagery sessions