Ch. 8: Communication
When assessing a client's nonverbal communication, the nurse will assess which characteristic as the most expressive part of the body? a) Eye contact b) Posture c) Facial expressions d) Hand gestures
Correct Response: c) Facial expressions Explanation: The face is the most expressive part of the body. Eye contact, the lack of eye contact, posture, gesture, and silence are other methods of nonverbal communication.
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic? a) "Have you ever thought of laser surgery?" b) "Why don't you try laser surgery?" c) "My grandfather also benefited from laser surgery." d) "You should try laser surgery."
Correct Response: a) "Have you ever thought of laser surgery?" Explanation: "Have you ever thought of laser surgery?" is a therapeutic response and encourages the client to express his views. Statements like, "You should try laser surgery"; "Why don't you try laser surgery"; and "My grandfather also benefited from laser surgery" are nontherapeutic and are equivalent to giving advice.
A nurse is caring for a client with a diagnosis of metastatic lung cancer. The nurse finds the client sitting in a chair while staring out the window. The nurse conveys caring by saying: a) "Tell me what is on your mind." b) "Don't worry. You will be just fine in another day or two." c) "Your doctor knows best." d) "Cheer up. Tomorrow is another day."
Correct Response: a) "Tell me what is on your mind." Explanation: Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Clients tend to interpret them as a lack of real interest in what they have said. This client is faced with a serious diagnosis and body language would indicate the client is in deep thought. Cliches such as "don't worry,""cheer up," or "your doctor knows best" do not convey care on the part of the nurse. The simple action of asking what is on the client's mind opens up lines of communication for the client to express his feelings.
When the preoperative client tells the nurse that he cannot sleep because he keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is: a) "The thought of having surgery is keeping you awake." b) "You have a great surgeon. You have nothing to worry about." c) "You shouldn't be nervous. We perform this procedure every day." d) "Sounds as if your surgery is a pretty scary procedure."
Correct Response: a) "The thought of having surgery is keeping you awake." Explanation: Reflection means identifying the main emotional themes.
A nurse is completing a health history with a client being admitted for a mastectomy. During the interview, the client states, "I don't know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening? a) "You seem unsure. Tell me your concerns about your surgery." b) "I agree. If I were you, I would get a second opinion before the surgery." c) "Don't worry, I am sure your physician knows what he is doing." d) "I can see this interview is making you uncomfortable. We can continue later."
Correct Response: a) "You seem unsure. Tell me your concerns about your surgery." Explanation: To understand the client's perspective, the nurse uses therapeutic communication techniques to encourage verbal expression. The use of active listening facilitates therapeutic interactions. Giving clients the opportunity to be heard helps them organize their thoughts and to evaluate their situation more realistically. The nurse should not give opinions, sway a client's opinion, or avoid an uncomfortable discussion.
During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking, "How many times have you been hospitalized this year for your back pain?" This is an example of which type of question? a) Closed question b) Sequencing question c) Reflective question d) Open-ended question
Correct Response: a) Closed question Explanation: An open-ended question is often used when the nurse is obtaining a nursing history and allows the client to reply with a wide range of possible responses, thus encouraging free verbalization. A closed question is answered by one or two words, often "yes" or "no." A sequencing question is used to place events in a chronological order and to investigate a possible cause-and-effect relationship. A reflective question involves repeating what the person has said or describing the person's feelings.
The nurse and the physical therapist discuss the therapy schedule and goals for a client on a rehabilitation unit. What type of communication is occurring between the nurse and the therapist? a) Interpersonal b) Organizational c) Small-group d) Intrapersonal
Correct Response: a) Interpersonal Explanation: The nurse and physical therapist are engaging in interpersonal communication, which occurs between two or more people with the goal to exchange messages. Intrapersonal communication, or self-talk, is the communication that happens within the individual. Small-group communication occurs when nurses interact with two or more individuals. Organizational communication occurs when individuals and groups within an organization communicate to achieve established goals.
A nurse enters the client's room and introduces himself stating, "Hello, Mr. Alonso. My name is Anthony Bader. I will be your registered nurse today. I will be providing your nursing care and I will be with you until 3:30 PM. If you need anything, please call me on my phone or put your light on." He then gives the client a printed card with this information. In the helping relationship, what does this represent? a) Orientation phase b) Termination phase c) Intimate phase d) Working phase
Correct Response: a) Orientation phase Explanation: The orientation phase consists of introductions and an agreement between the nurse and the client about their mutual roles and responsibilities.
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship? a) Working phase b) Evaluation phase c) Termination phase d) Orientation phase
Correct Response: a) Working phase Explanation: During the working phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions.
A newly graduated nurse tells the charge nurse about difficulty obtaining the client's cooperation in his care. What would be the charge nurse's most appropriate response? a) "The best way to obtain your client's cooperation is by being very firm with your instructions." b) "The best way to obtain your client's cooperation is by first obtaining your client's trust." c) "The best way to obtain your client's cooperation is by following strict agency protocol." d) "The best way to obtain your client's cooperation is by always maintaining a professional distance."
Correct Response: b) "The best way to obtain your client's cooperation is by first obtaining your client's trust." Explanation: Successful implementation of interventions requires that the client trust the nurse. Following strict protocol or being very firm may not always allow for the needs of the client. It is important to remain professional, but the nurse needs to connect with the client to win the client's trust.
A client scheduled to have hip replacement surgery states, "I am so scared of the surgery and of the anesthetic." What is the best response by the nurse? a) "You really don't have anything to worry about." b) "What questions do you have about the surgery?" c) "Your wife will be in the surgery waiting room the entire time." d) "What will happen if you don't have surgery?"
Correct Response: b) "What questions do you have about the surgery?" Explanation: The nurse should allow the client time to express his fears about the anesthesia and the surgery. Telling the client that his wife will be waiting, or not to worry, or asking what will happen if he doesn't have the surgery, do not address the client's concerns.
In which of the following situations would the SBAR technique of communication be most appropriate? a) A nurse is teaching a client about the benefits of smoking cessation and the risks of continuing to smoke. b) A nurse is calling a physician to report a client's new onset of chest pain. c) A nurse is facilitating a family meeting in order to coordinate a client's discharge planning. d) A nurse is explaining the process of bone marrow biopsy to a client who is scheduled for the procedure.
Correct Response: b) A nurse is calling a physician to report a client's new onset of chest pain. Explanation: There are numerous applications of the SBAR technique of communication, including nurse-physician communication surrounding acute client developments. The technique is not normally applied in client education or in communication between the health care team and patients' families.
A student nurse is attempting to improve her communication skills. Which therapeutic communication skill is appropriate? a) Use cliches to enhance a client's understanding of information. b) Control the tone of the voice to avoid hidden messages. c) Avoid the use of periods of silence. d) Be precise and inflexible regarding the intent of the conversation.
Correct Response: b) Control the tone of the voice to avoid hidden messages. Explanation: Conversation skills involve controlling the tone of one's voice so that exactly what is intended is conveyed, and there is no hidden message. Periods of silence have an important role in conversations because they allow for periods of reflection. Cliches should be avoided, and the conversation should be flexible.
Which guideline should a nurse use when choosing a position (location) in relation to a client during a verbal interaction? a) The nurse should ask the client where he would like the nurse to position herself and move accordingly. b) Take note of the client's cues when choosing a position and act on these cues. c) Assess the client's culture during the initial meeting or assessment. d) Choose a position that is no closer than 2 feet, but no farther than 4 feet.
Correct Response: b) Take note of the client's cues when choosing a position and act on these cues. Explanation: Preferences regarding space and territoriality vary greatly. A useful strategy to foster good communication is to note, and act on, client cues. While preferences are often culturally rooted, knowing a client's culture does not provide all the data a nurse needs in order to accommodate variables around positioning. Rigid parameters are likely to be simplistic, and explicitly asking the client may make him feel uncomfortable.
A nurse and an older adult patient with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point? a) The nurse is not concerned with the patient's pain. b) The nurse will be sensitive to the patient's emotional barriers. c) The nurse will tell the patient that teaching is not important. d) The nurse does not actively listen to the client.
Correct Response: b) The nurse will be sensitive to the patient's emotional barriers. Explanation: The nurse is trying to establish a good rapport with the patient and therapeutic communication is mandatory. The nurse should be sensitive to all needs of the patient both physical and emotional. Teaching is an important aspect of nursing and the patient should never regard it as unimportant nor should the nurse not listen to what the patient is saying. The degree with which people are physically comfortable will influence their ability to communicate. Once rapport is established, the nurse and client can communicate and discuss issues such as pain.
A client comes into the urgent care center to have sutures removed on his right arm. The nurse assesses the sutures and finds significant crusting along the suture line. The client indicates he didn't have time to get his sutures removed a week prior as directed. The nurse soaks the crust and attempts to remove the sutures. As the nurse attempts the suture removal, the client frequently pulls his arm away and tells the nurse, "you do not know what you are doing." In response, the nurse should answer: a) "You are the cause of the problem here. I do not have to tolerate this behavior and you are free to leave." b) "How would you know if I know what I am doing or not?" c) "Sir, I understand this is uncomfortable but I assure you I am experienced with this task and would like to continue." d) "I am sorry this is hurting you but you are hurting my feelings."
Correct Response: c) "Sir, I understand this is uncomfortable but I assure you I am experienced with this task and would like to continue." Explanation: When interacting with clients, family members, other nurses, physicians, and other members of the health care team, nurses should communicate in a way that demonstrates respect for all parties. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors that are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a nondefensive manner. The client in this scenario is acting inappropriately but the nurse needs to be assertive, maintain composure, and handle the situation. The nurse should not use "You" statement, instead "I" statements that relate to the task at hand. Asking the client how he would know if the nurse was performing the task is provocative and inappropriate.
A female client reports to her primary care physician with aggravated chest pain. The physician orders a stress test. The client tells the nurse that she does not want to take the test and feels she should instead continue with the medication a little longer. Understanding that the client is anxious, what is the most appropriate response by the nurse? a) "Emergency equipment is always kept ready." b) "Most people tolerate the procedure quite well." c) "Tell me more about how you are feeling." d) "Don't you want to improve your health?"
Correct Response: c) "Tell me more about how you are feeling." Explanation: The client may have been anxious due to fear and anxiety related to the stress test. The nurse should try to explore the client's feelings by letting her express her concerns. Asking the client open-ended questions is best because it expresses concern for the client, and encourages the client to verbalize her feelings. Stating that emergency equipment is always kept ready evokes more fear and interrupts communication. Questioning whether the client wants to get well, or that others have tolerated this procedure quite well, is inappropriate.
A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? a) Pity b) Sympathy c) Empathy d) Indifference
Correct Response: c) Empathy Explanation: The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.
The nursing instructor is discussing communication with a student. The student identifies that a contract is made with the client during which phase of the nurse-client relationship? a) Termination phase b) Intimate phase c) Orientation phase d) Working phase
Correct Response: c) Orientation phase Explanation: The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are used as a therapeutic tool to help a client develop more insight and control over his or her own behavior.
Which activity takes place during the working phase of the nurse-client relationship? Select all that apply. a) The client and nurse identify goals of the relationship. b) The client identifies the goals accomplished in the relationship. c) The client participates actively in the relationship. d) The client genuinely expresses concerns to the nurse. e) The client describes the role that the nurse plays in the relationship.
Correct Response: c) The client participates actively in the relationship. , d) The client genuinely expresses concerns to the nurse. Explanation: The working phase of the nurse-client relationship involves active participation toward goals and genuine expression of concerns and feelings. Identification of goals and relationships occurs in the orientation phase. Identifying that goals have been accomplished is characteristic of the termination phase.
The nurse considers which client aspect as nonverbal communication? a) The client's values and beliefs b) The client's religious practices c) The client's tone of voice d) The client's accent
Correct Response: c) The client's tone of voice Explanation: A person communicates by gestures, facial expressions, posture, space, appearance, body movement, touch, vocal tone, volume, and rate of speech. All are examples of nonverbal communication.
A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario? a) The orientation phase b) The termination phase c) The working phase d) The introduction phase
Correct Response: c) The working phase Explanation: There are three phases of a helping relationship: the orientation phase, the working phase, and the termination phase. The introduction phase is not a valid phase, yet the nurse will introduce herself during the orientation phase. The scenario defines characteristics of the working phase, during which the nurse and client work together to meet the client's physical and psychosocial needs. During the orientation phase, the tone and guidelines for the relationship are established. The termination phase occurs when the conclusion of the initial agreement is acknowledged.
A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique? a) giving information b) encouraging elaboration c) giving false reassurance d) seeking clarification
Correct Response: c) giving false reassurance Explanation: False reassurance means giving reassurance that is not based on the real situation. It is a way of minimizing the client's situation and violates the client's trust. Seeking clarification means helping the client put unclear thoughts or ideas into words. Giving information involves sharing accurate information about the client's health and well-being in a timely manner. Encouraging elaboration is a technique used to help the client describe more fully the concerns or problems being discussed.
A nurse is interviewing a client for the establishment of long-term care insurance. During the interview, the nurse asks questions regarding the client's past medical history. The nurse is the: a) receiver. b) target. c) sender. d) decoder.
Correct Response: c) sender. Explanation: A sender is a person or group with a purpose for the communication.
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. What is a characteristic of empathy? a) Experiencing feelings similar to that of the client b) Caring for the client without negative judgment c) Conveying genuine care to the client d) Identifying with the client's feelings
Correct Response: d) Identifying with the client's feelings Explanation: Empathy is the ability to identify with client feelings. Congruence refers to feelings that match the expressions of the client. Positive regard means conveying genuine care to clients without passing any negative judgment on them.
A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques? a) Reflective question b) Validating question c) Closed question d) Open-ended question
Correct Response: d) Open-ended question Explanation: The nurse's question allows for a wide range of responses and encourages free verbalization, characteristics of a useful open-ended question. Validating questions allow the nurse to confirm what was previously said, while closed questions necessitate a "yes" or "no" answer. A reflective question or comment repeats what the client has recently said.
Which factor is most important in the development of rapport between nurse and client? a) Kindness b) Happiness c) Skill d) Trust
Correct Response: d) Trust Explanation: Rapport is a feeling of mutual trust between nurse and client. Kindness is the quality of being friendly, generous, and considerate. Happiness is the state of being happy. Nurses have skills or a particular ability related to caring for clients. Other traits and abilities, such as kindness, happiness, and skill, may foster rapport in particular client interactions, but trust remains the central component of rapport.
Several nurses on the same hospital unit communicate on the same social networking site. A nurse posts the following statement to the social networking page, "The lady in room 34 with heart failure was a train wreck!" This statement: a) is acceptable because the hospital's name was not mentioned. b) is unacceptable because the diagnosis of heart failure was listed. c) is acceptable because the client's name was not used. d) is unacceptable and breaches the client's confidentiality rights.
Correct Response: d) is unacceptable and breaches the client's confidentiality rights. Explanation: In most cases, inappropriate disclosures of information are unintentional. Nurses may expect that information they post is private, but in reality it can be shared with multiple other recipients. As well, it is also incorrect to assume that once information has been deleted from a site, it is no longer available. Describing a client by using a room number or diagnosis rather than a name is still considered a breach of confidentiality and a violation of client privacy.
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out? a) attending to physical health care needs b) developing solutions that are enacted c) establishing trust and rapport d) reviewing health changes
Correct Response: d) reviewing health changes Explanation: During the termination phase of the nurse-client relationship, the nurse and the client review health changes and how the client has dealt with physical and emotional responses. During the orientation phase of the nurse-client relationship, the nurse and client work toward establishing trust and rapport. During the working phase of the nurse-client relationship, the nurse attends to the physical health care needs and develops solutions that are acted upon by the client.