Ch 8 PrepU
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic? "You should try laser surgery." "Why don't you try laser surgery?" "Have you ever thought of laser surgery?" "My grandfather also benefited from laser surgery."
"Have you ever thought of laser surgery?" "Have you ever thought of laser surgery?" is a therapeutic response and encourages the client to express the client's own views. Statements such as, "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.
Which statements made by the nurse acknowledge the client as a human being? Select all that apply. "Hey buddy, how was your night last night?" "Hi Tom. Please take your clothes off and put this gown on with the opening in the back." "Honey, can you tell me why you are crying?" "I am going to cleanse your back; turn over for me, sweetie." "I have your medications ready for you, Ms. Jackson." "Mr. Smith, I will be taking you to x-ray now."
"Mr. Smith, I will be taking you to x-ray now." "I have your medications ready for you, Ms. Jackson." Nurses must focus on the whole client and not merely the client's diagnosis. Clients report that nothing is more discomforting than to be treated as merely an object of care rather than a client. Unless given permission to do otherwise, the nurse should address the client formally, using the appropriate title, such as Mr., Mrs., Ms., or Dr., and the client's last name rather than slang terminology such as "honey" or "sweetie." If appropriate, ask the client whether the client prefers to be called by the first or last name. Many adults find it intrusive or rude to be called by their first name. What distinguishes nursing from other health professions is its focus on the whole person, not simply the illness or dysfunction.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: ask all visitors to leave the room. ask the client if she is able to read. eliminate as many distractions as possible. ask the client's partner to leave the room to allow the client to focus.
eliminate as many distractions as possible. Factors that distort the quality of a message can interfere with communication at any point in the process. These distractors might be from the television, or from pain or discomfort experienced by the client. Visitors may remain in the room as long as the mother agrees and they do not interfere with the education session. It may also be beneficial for others to learn the care in the event that they too will be caregivers for the infant. For this reason, it is best for the client's partner to remain in the room.
A client was recently diagnosed with metastatic lung cancer. The nurse finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy? "I see you are upset. Would you like to talk?" "Don't worry, I have seen lots of people with cancer do fine." "I see you have been crying. Do you want me to call someone for you?" "I am sorry to hear you have cancer. I would be upset too, is there anything I can do?"
"I see you are upset. Would you like to talk?" Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Acknowledging the client's state, "I see you are upset" and asking the open-ended question, "would you like to talk" best demonstrates the use of empathy and helps the nurse become effective at providing for the client's needs while remaining compassionately detached. Sympathy, such as saying sorry, is not supportive and asking a closed question does not allow the client to express his or her concerns or fears. An offer to call someone is an example of avoidance, and makes the nurse appear uncaring. Telling the client not to worry is an example of giving false reassurance and is nontherapeutic and can give the client false hopes and expectations.
A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication? "Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you." "Close your eyes and take a deep breath. I know you were frightened, but the infant is healthy and everything is going to be okay." "This is great news. You don't have anything to worry about and the infant is doing well." "I can help you, please talk to me so that I know how I can help you."
"Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you." Nurses often rely on verbal and nonverbal cues from clients to verify whether client objectives or goals have been achieved. It is therapeutic to allow for a pause in the communication by giving the client time to think about the situation and what has happened. Rescuing, false reassurance, and moralistic judgement are not therapeutic and could lead to client disappointment, minimizing the client's concerns, or inference on what is the "right" way to feel.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse? A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's. A nurse posts pictures of a client who accomplished a goal of losing 100 lb and later deletes the photo. A nurse describes a client on Twitter by giving the client's diagnosis rather than the client's name. A nurse describes a client on Twitter by giving the room number rather than the name of the client.
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's. A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse's and do not represent those of the employer. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly.
A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client? Talk with the client's children to determine needs. Use a text-telephone device (TTD) for daily communication. Arrange for a sign language interpreter when discussing treatment. Consult the oncology nurse specialist.
Arrange for a sign language interpreter when discussing treatment. During the planning step of the nursing process the nurse develops and prioritizes an individualized plan of care in partnership with the client, family, and others as appropriate. The client with mental or physical limitations should be included in the plan as much as possible. A sign language interpreter allows the client to participate fully in the plan of care. Consulting with the client's children is not as beneficial because it places them in the difficult position of translating while experiencing the emotional strain of the parent's illness. A TTD line can assist in communication but is not as helpful as a medical interpreter. Consulting the oncology nurse specialist is not as helpful in communicating with this client as an interpreter.
When caring for a psychiatric client, a nurse would make a formal contract with the client during which phase of the nurse-client relationship? Working phase Termination phase Orientation phase Intimate phase
Orientation phase In the psychiatric setting, the orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are used as a therapeutic tool to help a client develop more insight and control over behavior. The working phase consists of the nurse and client working together to achieve the client goals established in the orientation phase. The termination phase consists of evaluating the client's progress toward meeting the goals and concluding the relationship. There is no intimate phase in the nurse-client relationship.
The nurse meets with the client to teach self-administration of low molecular weight heparin. During the initial part of the training the client shakes the head and asks the nurse to repeat the instructions. What action demonstrates that the nurse has assessed the client's communication abilities? The nurse asks the client if he or she is worried about giving oneself an injection. The nurse stops the instruction and tells the client that a call will be placed to the health care provider to get an order to have a home health nurse administer the medication. The nurse continues with the instructions and makes a mental note to repeat the initial instructions at the end of the training. The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe.
The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe. During the initial phase of the nurse-client relationship the nurse assesses the client's verbal and nonverbal communication. Shaking the head and requests to repeat what has been said points to a hearing deficiency. Facing the client, speaking slowly and clearly, and providing a visual demonstration is effective for communicating with individuals with a hearing impairment. Making a mental note to repeat instructions is a poor nursing action regardless of the communication difficulties of the client, because the nurses failed to let the client know the plan to repeat the instructions. Stopping the instruction and getting a home health nurse to administer the medication demonstrates that the nurse interpreted the client's communication as unwilling or as an inability to self-administer. This misinterpretation may result in an unnecessary healthcare expense. The nurse asking the client if he or she is worried demonstrates that the nurse is ignoring or not paying attention to the client's communication abilities.
Which nursing actions help improve listening skills when conversing with clients? Select all that apply. Sitting with the arms crossed Using facial expressions and body gestures to indicate attention to what the client is saying Listening for themes in the client's comments Pretending to listen to the client while performing a task rather than interrupting the client's conversation Always maintaining eye contact with the client in a face-to-face pose Thinking before responding to the client, even if this creates a lull in the conversation
Using facial expressions and body gestures to indicate attention to what the client is saying Thinking before responding to the client, even if this creates a lull in the conversation Listening for themes in the client's comments The following nursing actions would help improve listening skills when conversing with clients: using facial expressions and body gestures to indicate attention to what the client is saying; thinking before responding to the client, even if this creates a lull in the conversation; and listening for themes in the client's comments. The nurse should not cross the arms or legs while communicating with a client because this body language conveys a message of being closed to the client's comments. A face-to-face pose and maintaining eye contact would not be appropriate in all nurse-client relationships. The nurse would not pretend to listen to the client while performing a task rather than interrupting the client's conversation.
