Communication PREPU
The client responds to the nurse's questions by stating in a loud and abrupt tone, "Yes, I understand my diabetic diet and how to give my insulin." What type of message has the client sent to the nurse? Inconclusive Precise Clear Incongruent
Incongruent When the nonverbal metacommunication aspects of the message do not fit with the verbal message, the communication is considered incongruent.
A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult: an audiologist. an ophthamologist. a clinical psychologist. an optometrist.
an audiologist
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: ask the client's partner to leave the room to allow the client to focus. ask all visitors to leave the room. ask the client if she is able to read. eliminate as many distractions as possible.
eliminate as many distractions as possible
A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question? "I understand you have four kids; how many times have you actually been pregnant?" "All right, you have four children, is that correct?" "How old are your children?" "Were these term births?"
"I understand you have four kids; how many times have you actually been pregnant?"
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 Verbal Visual Body Language
Kinesthetic There are three forms of communication channels including kinesthetic, verbal, and visual. Kinesthetic is the form of touch used to convey emotional support for the client. The verbal mode of communication uses words to relay information, and visual uses gesture or actions to communicate. Body Language is a broad term for non-verbal communication that allows the nurse to observe uncommunicated behaviors of the client and can include several behaviors including: touch, eye contact, facial expressions, posture, gait, gestures, general physical appearance, grooming, sound, and silence.
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: "Are you allergic to any medications?" "Can you tell me the medications you take on a daily basis?" "Do you have and advanced directive or a living will?" "Can you tell me why your physician sent you here to be admitted?"
"Can you tell me why your physician sent you here to be admitted?" When obtaining a nursing history, use the open-ended question technique to allow the client a wide range of possible responses. It allows the client to express what he understands to be true, yet is specific enough to prevent digressing from the issue at hand. It encourages free verbalization. The greatest advantage of this technique is that it prevents the client from giving a simple "yes" or "no" answer that has the effect of limiting the client's response. Eliciting medication use, allergies, or advanced directive determination are examples of closed communication where only one or a few words are required for an answer.
A client has just been given a diagnosis of cirrhosis of the liver. Which statements by the nurse should be avoided because they could impede communication? Select all that apply. "Cheer up. Tomorrow is another day." "Your doctor knows best." "That's a lot of information to take in. Would you like to talk about it?" "Don't worry. You will be just fine in another day or two." "Everything will be all right."
"Cheer up. Tomorrow is another day." "Your doctor knows best." "Don't worry. You will be just fine in another day or two." "Everything will be all right."
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship? Orientation phase Working phase Termination phase Evaluation phase
Working Phase During the working phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions.
A student nurse is attempting to improve their communication skills. Which therapeutic communication skill is appropriate? Control the tone of the voice to avoid hidden messages. Avoid the use of periods of silence. Use cliches to enhance a client's understanding of information. Be precise and inflexible regarding the intent of the conversation.
Control the tone of the voice to avoid hidden messages. 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.
During an annual performance review with an employee, the nurse manager does not maintain eye contact and seems concerned about the time and the next appointment. What type of communication is the manager exhibiting? Consistent Verbal Nonverbal Clarifying
Nonverbal Use of eye contact as a nonverbal form of communication demonstrates attention, presence, and interest. In addition, listening can be hampered by the listener's lack of interest in the topic, premature interpretation of the message, or preoccupation with practice. The nonverbal cues that accompany the message are essential aspects of effective communication.
The term metacommunication is best defined as: congruent relationships in the spoken topics. documenting a conversation between the client and nurse. contextual factors that impede communication patterns. interpersonal bridge between verbal and nonverbal communication
interpersonal bridge between verbal and nonverbal communication Metacommunication is a communication about the client's communication or lack thereof. It is an implicit, but integral, part of the message and is an interpersonal bridge between the verbal and nonverbal components of communication.`
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? Open-ended question Validating question Closed question Reflective question
Open-ended question 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.
A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established? Orientation phase Working phase Termination phase All of the above
Orientation Phase During the orientation phase, the nurse will discuss with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the conclusion of the initial agreement is acknowledged.
The nurse is performing an admission interview with a new client diagnosed with acute coronary syndrome. For the nurse to obtain information and allow the client free verbalization, which question would elicit the most information? "Have you ever had chest pain prior to this admission?" "Could you tell me more about how you are feeling right now?" "I have had chest pain before, and it is really scary!" "Did you take any medication when you had the pain?"
"Could you tell me more about how you are feeling right now?" open-ended queshun
A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication? "Why are you treating me this way?" "You always act like this." "I think there is a better way to handle this." "What is your problem with me?"
"I think there is a better way to handle this." 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, which 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 non-defensive manner. "I" statements—"I feel . . ." and "I think . . ."—play an important role in assertive statements. They communicate personal feelings and preferences without expressing a judgment or blaming another person.
The nurse must employ appropriate interviewing techniques to elicit accurate and complete health information. Which statement is an example of an open-ended question or comment? "Tell me what brought you to the hospital this morning?" "Are you having pain right now?" "You seem upset today. Are you?" "I'll be back in 30 minutes to check on your pain relief."
"Tell me what brought you to the hospital this morning?" Using an open-ended question or statement when interviewing a client allows for a wide variety of responses and encourages free verbalization. When determining why a client sought health care, this is a valuable way to elicit detailed responses during the assessment process. Asking "Are you having pain right now?" and "You seem upset today. Are you?" require a client to answer with a yes or no response or very little verbiage that will require follow-up questions to elicit valuable information. "I'll be back in 30 minutes to check on your pain relief" is an information-giving statement by the nurse and does not require a response from the client.
A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client? "I will be by your side throughout the procedure; the procedure will be painless if you don't move." "The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." "The procedure may take only 2 minutes, so you might get through it by mentally counting up to 120." "You may feel very uncomfortable when the needle goes in, but you should breathe rhythmically."
"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position."
A nurse has developed strong rapport with the wife of a client who has been receiving rehabilitation following a debilitating stroke. The wife has just been informed that her husband will be unlikely to return home and will require care that can only be provided in a facility with constant nursing care. The client's wife tells the nurse, "I can't believe it's come to this." How should the nurse best respond? "This must be very difficult for you to hear. How do you feel right now?" "Why do you think that the care team has made this recommendation?" "Do you understand that everyone here has your husband's best interest at heart?" "What would help you accept that this is best for both of you?"
"This must be very difficult for you to hear. How do you feel right now?" Asking the wife to elaborate on her feelings may be therapeutic as well as insightful. Asking about the reasons underlying the care team's recommendation is less likely to be of benefit. Attempting to redirect the wife to a positive outlook at this early point is insensitive. The working phase is usually the longest phase of the helping relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The nursing roles of teacher and counselor are performed primarily during this phase. These roles involve motivating the client to learn and to implement health promotion activities, to facilitate the client's ability to execute the plan of care, and to express feelings about health problems, nursing care, any progress or setbacks, and any other areas of concern.
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask: "Do you check your blood pressure and pulse before you take your medication?" "Have you tried exercising at all in the last week or two?" "Were you tired and depressed before starting the new medication?" "Tell me about the foods you are eating."
"Were you tired and depressed before starting the new medication?" Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence. The symptoms the client is complaining of are common adverse effects of this drug. Sequencing can determine the cause and effect in this scenario. Clients taking metoprolol should check their blood pressure and pulse before taking their medication. Asking about the current diet or exercise regimen does not uncover the cause and effect.
A 70-year-old female client had a cholecystectomy four days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask the client in order to assess the her orientation? "Is your name Evelyn?" "Are you in a hospital?" "Is today the first day of the month?" "What day of the week is it?"
"What day of the week is it?" Asking the client to identify the day of the week represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking close-ended questions, which are answered with a simple yes or no response. The remaining responses are all close-ended questions and therefore would not provide an accurate assessment of the client's orientation.
The nurse faculty is observing a student nurse gather data from a client. Which question, if asked by the student, would indicate to the faculty that the student has a clear understanding of open-ended questions? "Do you take this medication daily?" "Why did the health care provider prescribe this medication for you?" "When was the last time you had your prescription refilled?" "How many tablets do you take at one time?"
"Why did the health care provider prescribe this medication for you?" Open-ended questions (e.g., "Why was this medication prescribed for you?") give the client an opportunity to express what he or she understands and prevent the client from answering with "yes" or "no." The other three responses require a "yes" or "no" response, so they are closed-ended questions.
A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse? "Don't worry about labor, I have been through it and it is not so bad." "There are many good medications to decrease the pain; it will not be so bad." "You're worried about how you will tolerate the pain associated with labor." "I would recommend keeping a positive attitude."
"You're worried about how you will tolerate the pain associated with labor." Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives.
A nurse touches the client's hand while discussing his diagnosis. This action is a(an): dynamic process. translation. communication channel. auditory channel.
Communication Channel Communication channel is the carrier of the message; touch can be a channel.
Which qualities in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached? Sympathy Empathy Kindness Commiseration
Empathy Empathy refers to intuitive awareness of what the client is experiencing. It helps the nurse perform activities and remain emotionally neutral. Sympathy means feeling as emotionally distraught as the client. If the nurse sympathizes with the client, the nurse may feel equally disturbed, and performance may be affected. Kindness and commiseration also have an emotional component attached to them.
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? Indifference Pity Sympathy Empathy
Empathy 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 nurse is visiting a hospice client in his home. He is explaining the difficulties he is having with his home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is utilizing which therapeutic nurse-client communication technique? Restating Clarification Reflection Encouraging elaboration
Encouraging elaboration
When caring for a psychiatric client, a formal contract is made with the client during which phase of the nurse-client relationship? Intimate phase Orientation phase Working phase Termination 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.
A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response? Be silent and allow the client to continue speaking when ready. Smile and say, "Don't worry, I am sure the physician is doing a good job." Nod and say, "I agree. If I were you, I would get a new doctor." Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
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. assertive. passive. nurturing.
aggressive
A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should: ask questions as quickly as possible. use only open-ended questions. tell the client to rest and allow a family member to answer. allow the client to set the pace.
allow the client to set the pace
The mother of a toddler is deciding if she wants to allow her child to receive the recommended immunizations. The clinic nurse responds, "If you don't immunize your child you are jeopardizing the health of other children." What type of approach does this response indicate? authoritarian or belittling guilt inducement or approval/disapproval advocacy or enforcing rights dictatorial or bossing
guilt inducement or approval/disapproval This response by the nurse attempts to induce guilt on the parent to make what the nurse views as the best choice. Authoritarian responses dictate what the client should do based on the health care worker's professional opinion. An advocacy response supplies the client with information to make the decision.
A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse: stands at the foot of the bed and maintains constant eye contact. sits at the client's bedside and faces the client. asks all visitors to leave the room. holds the medical record while sitting at the bedside and crossing the legs.
sits at the client's bedside and faces the client. When possible, sit when communicating with a client. Do not cross the arms or legs because that body language conveys a message of being closed to the client's comments. Constant eye contact may be culturally inappropriate. Visitors may remain in the room if allowed by the client and if they do not obstruct history gathering.
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: staring into the neonate's eyes and smiling. softly humming a song near the neonate. swaddling the child and gently stroking its head. offering the neonate infant formula.
swaddling the child and gently stroking its head. Touch is the most highly developed sense at birth. Tactile experiences of infants and young children appear essential for the normal development of self and awareness of others. It has also been found that many older people long for touch, especially when isolated from loved ones because of hospitalization or long-term care facility care. Vision, taste, and hearing are not as fully developed as touch in the neonate.
