Chapter 8 Communication

A nurse is communicating the plan of care for a client who is unconscious. Which nursing actions best facilitate this process? Select all that apply.

-The nurse is careful what is said in the client's presence because hearing is the last sense to go. -The nurse assumes the client can hear and discusses things that would ordinarily be discussed. -The nurse speaks with the client before touching the client.

Which statements describe the qualities of a helping relationship? Select all that apply.

-The helping relationship is built on the client's needs, not on those of the helping person. -A helping relationship is dynamic. -A helping relationship is purposeful and time limited.

A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?

"Have you ever thought of laser surgery?"

To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others?

Therapeutic communication

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?

Closed question

A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response?

"Share with me the advantages and disadvantages of your options as you see them."

For which purposes would observing silence be appropriate? Select all that apply.

-To allow the client time to reflect on the client's thoughts -To allow the client time to reflect on communication that has occurred -To allow the client time to formulate an answer after asking the client a question -To allow the client time to compose oneself when the client is upset

Which is a characteristic of a person-centered or helping relationship?

An unequal sharing of information Explanation: A helping relationship is characterized by an unequal sharing of information. The client shares information related to personal health problems, and the nurse shares information in terms of a professional role

In a helping relationship, the nurse would most likely perform what action?

Establish communication that is continuous and reciprocal.

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?

Interpersonal

The nurse is communicating with a client who begins to cry. The nurse places a hand on the client's arm and sits quietly at the client's beside. What mode of communication is the nurse using to offer caring and comfort for the client?

Kinesthetic

A client arrives at the emergency department after experiencing several black, tarry stools. The nurse should assess for the cause of the client's complaint by:

asking the client whether the client has recently taken ferrous sulfate (iron) or bismuth subsalicylate. Explanation: Both ferrous sulfate and bismuth subsalicylate can cause darkening of the stool, and either may be the causative agent in this case.

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?

Arrange for a sign language interpreter when discussing treatment.

A nurse states the following to another nurse who is constantly forgetting to wash hands between clients: "It looks like you keep forgetting to wash your hands between clients. It's really not safe for your clients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech?

Assertive

While assessing a client, the nurse notices that the client seems to be distracted from the questions being asked. The nurse attempts to identify factors that may be affecting the communication. What would the nurse identify as an internal influencing factor?

Experience

A nurse is on lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. One of the physicians, who is in charge of the nurse's clients, points at the nurse and states, "That guy needs to get fired." The best response by the nurse would be to:

ask to speak to the physician in private and address the disrespectful remark. Explanantion: When disruptive physician behavior occurs, it is best to respond assertively and confront the physician directly. If this is not possible, ask to speak to the physician in private and address any disrespectful remarks or behaviors. Nurses should factually document the occurrence of any bullying behaviors and speak to a nurse-manager if the behavior continues.

A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse?

"I know this is hard for you. Is there any way I can help?"

The child of a client who just died in a hospice unit arrives and asks, "May I please stay and sit at the bedside? I really wanted to be here so my dad would not die alone." Which statement made by the nurse best demonstrates the use of empathy?

"I will close the door so you can spend some quiet time at the bedside."

A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening?

"You seem unsure. Tell me your concerns about your surgery."

A client has cancer, but the significant other does not want the client to know the diagnosis. The nurse demonstrates sensitivity to the significant other and works with the couple to achieve desired outcomes. What kind of behavior is the nurse exhibiting?

Empathy

The nurse-client relationship depends on communication. Effective communication between the nurse and the client encompasses which aspects? Select all that apply.

Spoken words Sight Touch Observation

Which guideline should a nurse use when choosing a position (location) in relation to a client during a verbal interaction?

Take note of the client's cues when choosing a position and act on these cues.

When the nurse communicates with a newly admitted client, the nurse must pay particular attention to nonverbal behaviors. The nurse considers which characteristic as nonverbal communication?

The client's tone of voice explanation:Nonverbal communication refers to the use of body language, such as gestures, facial expressions, posture, space, appearance, body movement, touch, voice tone and volume, and rate of speech.

The newly hired nurse is collecting assessment data for an upcoming surgical procedure from a client who speaks English as a second language. Which statement or question made by the newly hired nurse would indicate to the nurse manager that intervention is needed?

"Do you have any questions about your cholecystectomy?"

The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. What is the most appropriate response by the nurse to decrease the client's anxiety?

"I will start an IV that will add fluids directly to the blood stream." Explanation:The nurse should explain the procedure and its purpose.

The client is talking to the nurse about recent health problems of immediate family members and the strain the client has been under trying to care for them. The client begins to cry. What response by the nurse demonstrates the most empathy?

"Just take your time. I am listening."

A nurse is performing an admission assessment with a non-English speaking client. Which actions can the nurse take to enhance communication? (Select all that apply.)

-Use an electronic translator. -Contact a telephone-based medical interpreter. -Request assistance from an agency interpreter.

Which nursing actions help improve listening skills when conversing with clients? Select all that apply.

-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 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?

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.

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 enters the client's room and begins the process of establishing a nurse-client relationship. The nurse introduces oneself and informs the client how long the nurse will be caring for the client. What additional statement does the nurse need to communicate with the client?

"Let me know if you have concerns regarding your care."

A nurse visits a female victim of sexual assault. During the visit the client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse?

"Tell me more about the aspects that make you feel as if it happened yesterday."

A client who underwent a hysterectomy 4 days ago says to the nurse, "I wonder if I'll still feel like a woman." Which response would most likely encourage the client to expand on this and express concerns in more specific terms?

"Feel like a woman . . ." Explanation:The best response of the options listed is the statement "Feel like a woman..." This response is a reflective comment, which allows the client to reflect and elaborate on feelings.

A nurse is caring for a client with depression. The nurse finds that the client is withdrawn and does not communicate with others. What is the most appropriate response by the nurse?

"Is that a new shirt you're wearing?" Explanation: When the client is not talking, the nurse should use the observation technique of therapeutic communication. The nurse should complement the client to get the client's attention. Wearing a new shirt is an observation about the client that would draw communication from the client. The nurse should avoid direct questions to a client who is experiencing depression.

The nurse is communicating with a client following a routine physical examination. Which statement best demonstrates summarization of the appointment?

"We reviewed your plans for your new diet and medications. Do you have any other questions?"

During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:

"What did your health care provider tell you about your need to be admitted?"

The nurse completes the admission process of a client to an acute care facility. Which statement by the nurse demonstrates the communication technique of focusing?

"You are hoping to figure out the cause of your extreme fatigue during this hospital stay."

The nurse takes into consideration factors that influence communication when communicating with clients. Which situations accurately reflect communication that considers these variables? Select all that apply.

-A nurse uses simple language and demonstrations to explain a procedure to a preschooler. -A nurse checks a client's occupation for clues on how this will affect communication but avoids stereotyping the person. -A nurse takes into consideration a client's culture when planning how far away to sit when communicating.

Which characteristics would indicate a professional relationship? Select all that apply.

-An emphasis on addressing the client's needs in the current situation -The relationship ending with goal achievement

A nurse needs to complete an assessment and vital signs on a client who has Alzheimer disease. How should the nurse approach this client to gain cooperation? Select all that apply

-Approach the client from the front. -Use the client's name. -Smile and maintain eye contact.

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 during this phase of the relationship?

Reviewing health changes

Which technique would a nurse employ when using listening skills appropriately when interviewing a client?

The nurse would listen to the themes in the client's comments.

In the provision of care and the establishment of the therapeutic relationship, the nurse must first:

be aware of one's own personality.

A client presents to the urgent care clinic with ear pain. The client reports a medical history of trigeminal neuralgia. The nurse is not familiar with trigeminal neuralgia. When the client asks whether the two conditions could be related, which response by the nurse is best?

"I honestly do not remember specific details regarding trigeminal neuralgia; let me research it."

A nurse finds that a client has infiltration around the IV line that needs to be removed. What explanation should the nurse give to reduce the client's anxiety?

"I know that you are anxious, but the IV location needs to be changed."

A client comes into the urgent care center to have sutures removed on an arm. The nurse finds significant crusting along the suture line. The client states not having time to get the 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 the arm away and tells the nurse, "You are taking too long and it is hurting a little bit. Just pull them out and get it over with." Which statement is an example of appropriate therapeutic response?

"It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them."

A nurse is caring for an older adult client hospitalized following a hip fracture. Which actions by the nurse will promote the development of a therapeutic relationship? Select all that apply.

-Asking the client when the client would like to have the bed linens changed -Encouraging the client to talk about the client's life

A client reports to a primary health care provider with aggravated chest pain. The health care provider prescribes a stress test. The client tells the nurse about not wanting to take the test and wanting to continue taking medication for now. Understanding that the client is anxious, which action should the nurse take first to provide education needed for this client?

Ask the client "What has your health care provider shared with you about stress tests?"

A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication?

Assess how the client would like to communicate

A nurse is interviewing a client who has come to the clinic for a follow-up visit. The nurse notices the client does not make eye contact and speaks while looking down. How should the nurse respond?

Assume a position at eye level with the client and continue with the interview. When communicating with most clients, it is best to position oneself at the client's level and make frequent eye contact. Eye contact is perhaps among the most culturally variable nonverbal behaviors, and can be misunderstood as embarrassment, nervousness, or a problem with the client. Asian, Native American/First Nations, Indochinese, Arabian, and Appalachian people may consider direct eye contact impolite or aggressive, and they may avert their eyes during the interview. Stopping the interview, staying silent, touching the client, and forcing eye contact will make the client uncomfortable and should be avoided.

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?

Empathy

It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. What is a characteristic of empathy?

Identifying with the client's feelings

The postoperative client refuses a blood transfusion due to religious beliefs. The nurse calls the health care provider for an alternative treatment. What quality is the nurse demonstrating by advocating for the client's needs?

Trustworthiness

When attending a staff meeting, a nurse is participating in what type of communication?

When attending a staff meeting, a nurse is participating in what type of communication?

A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be:

aggressive.

An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is afraid of waking up during surgery. The best response by the nurse is to:

ask why the client thinks the client will wake up during surgery.

Each of the following facilitates a therapeutic nurse-client relationship except:

closed-ended questions.

A nurse is caring for a client admitted to the hospital for dehydration. The physical findings consistent with this diagnosis that the client's general appearance can nonverbally communicate to the nurse include:

easy wrinkling of the skin and sunken eyes. EXPLANATION:Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone.

An experienced nurse has been working with a client with heart failure. The client's lungs were clear to auscultation during the morning assessment; however, the afternoon assessment revealed bibasilar crackles and tachypnea. The nurse calls to give SBAR report to the covering health care provider. In the final step of the report the nurse should:

recommend 40 mg of furosemide be administered because the client had improvement with past administration.

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. In this case, the nurse plays the role in the process of communication of the:

sender. Explanation: The nurse is playing the role of the sender, which is a person or group who has a purpose for the communication and initiates and conveys the message. The receiver, or decoder, is the person or group who receive and interpret, or decode, the message. Target is not a term used to describe a role in the communication process.

A client arrives at a crisis center in a state of bipolar mania. The client has a flight of ideas and it is difficult for the nurse to obtain an adequate intake assessment. Which statement or question will elicit the most specific information?

"Are you allergic to any medications?"

Nurses on a hospital burn unit meet as a group to discuss procedures. Which statements accurately describe effective functioning in a group? Select all that apply.

-Group members elicit mutually respectful relationships. -The leader or other group members confront any member who dominates or thwarts the group process. -Group members support, praise, and critique one another.

A client in a mental health unit discusses personal thoughts and feelings with the nurse. The nurse can maintain the circle of confidentiality when reporting this information to which individuals? Select all that apply.

-The client's physician -The nurse from the oncoming shift -The unit's mental health technicians

The nurse is using nonverbal communication when caring for a group of clients. Which situation(s) reflects nonverbal communication? Select all that apply.

-The nurse is maintaining eye contact when changing a client's dressing. -The nurse has a smile when being thanked for caring for a family member. -The nurse assess a client is in pain from a grimace.

The nurse is beginning an assessment on a nonverbal client. The nurse must first:

establish eye contact prior to assessing, touching, and interacting with the client.