MED-SURG (VNSG 1429) CH. 5 "The Nurse-Patient Relationship" NCLEX-STYLE QUESTIONS
The nurse is caring for a patient who is preparing for surgery. Select all components that should be included in the plan of care for the patient when applying the holistic point of view? Select all that apply. A) Addressing the patient's fear of death B) Improving nutrition to improve wound healing C) Considering concerns about financial obligations D) Providing information on the nurse's religious beliefs E) Educating the patient on expected pain management F) Treating all patients the same regardless of cultural beliefs
A) Addressing the patient's fear of death B) Improving nutrition to improve wound healing C) Considering concerns about financial obligations E) Educating the patient on expected pain management Holism is a way of viewing people as whole individuals. This type of care includes the physical, emotional, social, economic, and spiritual needs of individuals and families. By addressing the patient's fear of death, improving nutrition, considering financial concerns, and educating on pain management are all examples of components of a holistic point of view. The patient's cultural beliefs should be included in the plan of care. Providing information on one's own religious beliefs is not included in the plan of care. (REF pg. 57)
Which factors may have affected a patient's decision to participate in his or her care? (Select all that apply.) A) Age B) Gender C) Religion D) Ethnicity E) Personality F) Educational level
A) Age C) Religion D) Ethnicity F) Educational level Age, ethnicity, personality, and educational level may affect a patient's decision to participate in care. Gender and religion are not listed factors in the patient's decision to participate in care. (REF p. 60)
Which factors may affect a patient's decision to participate in his or her care? (Select all that apply.) A) Age B) Gender C) Religion D) Ethnicity E) Personality F) Educational level
A) Age D) Ethnicity E) Personality F) Educational level Age, ethnicity, personality, and educational level may affect a patient's decision to participate in care. Gender and religion are not listed factors in the patient's decision to participate in care.REF: p. 60
The nurse is caring for a patient who recently underwent surgery for a colostomy. The patient is stressed and anxious about caring for the colostomy at home. To empower the patient and decrease the patient's anxiety, the nurse should employ which interventions? (Select all that apply.) A) Educate the patient on how to change the colostomy appliance. B) Provide the patient with educational information on caring for a colostomy. C) Encourage the patient to change the colostomy bag while the nurse supervises. D) Exclusively care for the patient's colostomy so the patient doesn't have to worry about it yet. E) Facilitate visits by individuals with colostomies so the patient can see that colostomies can be well-hidden.
A) Educate the patient on how to change the colostomy appliance. B) Provide the patient with educational information on caring for a colostomy. C) Encourage the patient to change the colostomy bag while the nurse supervises. Empowering the patient to participate in his or her own care will decrease the patient's anxiety and stress about how to care for the colostomy. The nurse can empower the patient by providing education, supervision, and feedback on how to change the colostomy bag and appliance. The nurse should provide colostomy care if the patient is unable to do so, but the nurse should encourage the patient to participate as much as possible. Exclusively caring for the patient's colostomy hurts the patient in the long run because it does not allow the patient to learn to care for the colostomy under supervision. Although it may be helpful to the patient at some point to be visited by individuals with colostomies, the question states that the patient is anxious about caring for the colostomy, not about how well the colostomy can be hidden.
A new nursing graduate observes that her preceptor is able to identify with and understand her patient's situation, feelings, and motives. This response to patients is characterized as: A) Empathetic B) Therapeutic C) Sympatheric D) Caring
A) Empathetic Empathy is the ability to identify with and understand another person's situation, feelings, and motives. The preceptor is displaying an empathetic response. Therapeutic response requires nurses to be aware of how their own attitudes, feelings, and beliefs affect others and valuing and accepting clients as unique individuals. Sympathetic response may entail becoming personally involved in the situation. Caring is a process evidenced by concern, understanding, and action.
Which statement by the nurse describes self? Select all that apply. A) I am a Christian. B) I love hiking in the woods. C) Sunset is my favorite time of the day. D) Family is important to me as a person. E) I am able to use problem-solving methods for decision making. F) I learned that self-awareness is a necessary component of nursing.
A) I am a Christian. D) Family is important to me as a person. E) I am able to use problem-solving methods for decision making. F) I learned that self-awareness is a necessary component of nursing. Self is the term used to describe one's personhood. It involves knowledge, experience, values, beliefs, perceptions, strengths, and weaknesses that make each individual unique. Enjoying hiking and sunsets are not components; they are expressions of what the nurse likes to do. (REF pg. 57-58)
The nurse caring for a patient with major depressive disorder on an acute psychiatric inpatient unit wishes to assume the role of helper for this patient. Which action on the part of the nurse constitutes the first step of establishing a therapeutic relationship and assuming the helper role? A) Keeping appointments to sit with the patient B) Encouraging the patient to eat at least half of every meal C) Encouraging the patient to attend group therapy sessions when ready D) Brushing the patient's hair and washing her face when she does not have the energy to do it
A) Keeping appointments to sit with the patient The first step in developing a therapeutic relationship is building trust. Keeping promises and appointments with the patient builds trust in the patient that the nurse will do what he or she says. Encouraging the patient to eat at least half of every meal and attend group therapy sessions when ready are interventions that would be part of the care plan. Brushing the patient's hair and washing her face when she does not have the energy to do it is a nursing duty that will help cultivate a therapeutic relationship, but it is not the first step.
Which activities promote effective communication? (Select all that apply.) A) Listening B) Observing C) Establishing trust D) Assertive communication E) Aggressive communication F) Ignoring the patient's culture
A) Listening B) Observing C) Establishing trust D) Assertive communication Two parts of effective communication are listening and observation. Effective communication requires having a trusting relationship. Assertive communication allows an individual to express help without hurting another person. Aggressive communication violates the rights of another person. Ignoring the patient's cultural background could be a barrier to communication.REF: pp. 61-64
Which statement is correct concerning language and use of interpreters in the health care system? A) Not using an interpreter can lead to errors. B) Family members can serve as interpreters in federally funded programs. C) Family members and nonmedical personnel will correctly relay all information. D) Nurses can assume that English is the primary language because the patient lives in the United States.
A) Not using an interpreter can lead to errors. Failure to use an interpreter has been identified as a factor in errors that are made in health care. A federally funded program is required to provide interpreters. Unless the patient reports speaking English very well, an interpreter should be offered. Family and nonmedical personnel may help with everyday conversation but may not relay medical information correctly. Not all individuals who live in the United States use English as the primary language.REF: pp. 62, 64
Which statement is correct concerning language and use of interpreters in the health care system? A) Not using an interpreter can lead to errors. B) Family members can serve as interpreters in federally funded programs. C) Family members and nonmedical personnel will correctly relay all information. D) Nurses can assume that English is the primary language because the patient lives in the United States.
A) Not using an interpreter can lead to errors. Unless the patient reports speaking English very well, an interpreter should be offered. Failure to use interpreters has been identified as a factor in errors that are made in the health care system. A federally funded program is required to provide interpreters. Unless the patient reports speaking English very well, an interpreter should be offered. Family and nonmedical personnel may help with everyday conversation but may not relay medical information correctly. Not all individuals who live in the United States use English as the primary language. (REF pg. 62)
The nurse enters the room of a patient dying of lung cancer and sees the patient's wife crying by the patient's bed. What is the most therapeutic intervention? A) Offer to sit with the wife and listen. B) State, "I was sad when my grandpa died, too." C) Tell the wife that she needs to go to the cafeteria and have some time to herself. D) Leave the room quietly before the patient's wife sees so she can grieve in peace.
A) Offer to sit with the wife and listen. The most therapeutic intervention on the part of the nurse is to offer to sit with the wife. This allows the wife the opportunity to accept or decline. Telling the wife, "I was sad when my grandpa died, too," makes the situation about the nurse and not the patient's wife and is not therapeutic. To tell the wife that she needs to go to the cafeteria for time to herself is to offer premature advice and is also not therapeutic. It is not appropriate to leave the room without first offering to sit with the patient's wife because the nurse is responsible to care for the patient and his family, not just the patient. (REF pg. 64)
The nurse is working with an unlicensed assistive personnel (UAP) to care for a patient with hepatic cirrhosis caused by chronic alcoholism. The UAP says to the nurse, "I don't know why we bother to care for this patient. He did this to himself." The nurse should base the response on which concept? A) Patients should not be judged by the staff. B) It is not the nurse's job to correct the UAP. C) All staff members are entitled to their own opinion. D) The UAP's actions are more important than her words.
A) Patients should not be judged by the staff. A nonjudgmental attitude of caring is essential to the practice of nursing. Although staff are entitled to their opinion, it is the nurse's responsibility to advocate for the patient; this requires correcting the UAP. Other co-workers, patients, and families may hear the UAP being disrespectful toward the patient.REF: p. 57, 61, 62
A patient who is scheduled for a biopsy of a lump in her breast says tearfully, "I am so afraid it will be cancer." The nurse replies, "There is no sense worrying about that until you know for sure." The nurse's response is an example of: A) Premature advice B) Commanding C) False reassurance D) Assuming truth of statements
A) Premature advice The statement by the nurse is an example of false reassurance. This is where an inappropriate personal opinion is offering to the effect that the client should not be concerned about something. This minimizes the client's feelings and may lead to feelings of guilt or anger. Premature advice is where the nurse offers advice without first encouraging the client to explore her feelings. The nurse cannot decide what is best for the client. Commanding is directing the client to do something that creates a power struggle or resistance. Assuming truth of statements means that the health care provider accepts information without questioning or clarifying the information. Misunderstandings can persist.
When providing patients with information on the care they are receiving is evidence that the nurse is displaying which nursing action? Select all that apply. A) Respecting the patient's autonomy B) Respecting the patient as a partner in care C) Respecting the patient's need for knowledge D) Respecting the patient's need to be informed about care E) Respecting the patient's health care provider by helping educate his or her patient
A) Respecting the patient's autonomy B) Respecting the patient as a partner in care C) Respecting the patient's need for knowledge D) Respecting the patient's need to be informed about care When providing patients with information on the care they are receiving, the nurse is acting as a patient advocate so that they may partner in their care. Respecting the patient's autonomy, respecting the patient as a partner in care, respecting the patient's need for knowledge, and respecting the patient's need to be informed about care demonstrate the nurse acting as a patient advocate. Respecting the patient's health care provider by helping educate the patient does not represent the nurse acting as a patient advocate. Nurses must work with health care providers, but this is not an example of providing information or of advocacy. (REF pg. 59-60)
Which behavior is typical of a therapeutic nurse-patient relationship? A) The nurse shares feelings honestly B) The nurse spends time with the patient in social settings C) The nurse shares her religious beliefs with her patients D) The nurse assures the patient that any information shared will be kept secret
A) The nurse shares feelings honestly In a therapeutic nurse-client relationship, the nurse may use friendly, informal communication in order to build trust and put the client at ease. Spending time with the client in social settings, and sharing religious beliefs with the client lead the relationship from the area of therapeutic more toward the area of social and are not appropriate. Assuring the client that any information shared will be kept secret cannot be done, because some client disclosures must be passed on to other health care providers.
Which technique should most appropriately be used by the LPN to communicate therapeutically? A) Use "I" statements to talk with the patient. B) Focus only on the patient's verbal statements. C) Focus on trivial issues with the patient. D) Use closed-ended questions.
A) Use "I" statements to talk with the patient. Use sentences that begin with "I" to indicate an acceptance of responsibility for one's feelings and thoughts. Observe the patient's gestures and nonverbal behavior. All behavior has meaning. Try to understand the meaning in the patient's behavior. Focus the patient on pertinent issues. Use open-ended questions. Stay clear of questions that can be answered with a "yes" or a "no." REF: p. 62
What should the nurse note when focusing on the skill of observation during communication? A) What the patient does with his or her body B) What the patient declares when questioned C) What the patient states to the health care provider D) What the nurse believes the patient is communicating
A) What the patient does with his or her body The nurse should note what the patient does with his or her body. The skill of observation includes the sense of vision. What the patient declares when questioned and what the patient states to the health care provider use the sense of hearing and therefore do not require observation. What the nurse believes the patient is communicating uses nursing intuition to determine what the patient is trying to communicate, but also is not an example of observation. (REF pg. 61-62)
Which statement by the nurse indicates a need for further teaching on the concepts of values and personal beliefs? A) "A belief is a conviction or opinion." B) "I don't like the way the teacher taught that concept." C) "Studying for tests helps students achieve better scores." D) "A value is a principle or standard that determines what is worthwhile."
B) "I don't like the way the teacher taught that concept." Stating an opinion on teaching methods is an attitude, not a concept of values and personal beliefs. A belief is an opinion. It is a belief that studying helps improve scores. A value does determine what is worthwhile. (REF p. 58)
Which statement by the nurse indicates a need for further teaching on the concepts of values and personal beliefs? A) "A belief is a conviction or opinion." B) "I don't like the way the teacher taught that concept." C) "Studying for tests helps students achieve better scores." D) "A value is a principle or standard that determines what is worthwhile."
B) "I don't like the way the teacher taught that concept." Stating an opinion on teaching methods is an attitude, not a concept of values and personal beliefs. A belief is an opinion. It is a belief that studying helps improve scores. A value does determine what is worthwhile.REF: p. 58
Which statement is an example of a nurse demonstrating empathy? A) "I feel like crying; don't you?" B) "I imagine that hearing that news was upsetting." C) "You are very upset at the bad news you just heard." D) "You must be worried after talking to the health care provider."
B) "I imagine that hearing that news was upsetting." Telling the patient, "I imagine that hearing that news was upsetting" demonstrates empathy. Saying, "I feel like crying; don't you?" "You are very upset at the bad news you just heard," or "You must be worried after talking to the health care provider," are responses based on the nurse's perspective and are not examples of a nurse displaying empathy for a patient's perspective. (REF p. 64)
The nurse is working with patients with Alzheimer disease at a long-term care facility. At lunchtime, the nurse enters the room of a patient, who has been in the facility for 10 years, to take him to the dining room in his wheelchair. How should the nurse address the patient? A) "Honey" to make him feel that he is cared for and loved. B) "Mr." because he is a patient and should be treated with respect. C) By his first name because he has been in the facility for 10 years and is like family to the nurse. D) "Honey," "Mr.," and by his first name are all acceptable ways to address the patient because he does not respond.
B) "Mr." because he is a patient and should be treated with respect. Unless the patient has expressly stated that he would prefer to be addressed by his first name only, the nurse should address him respectfully with the title "Mr." Regardless of length of stay or ability to respond, the nurse should not address the patient with his first name unless he has told the nurse to do so, and there is no evidence of this in the question. Terms of endearment such as honey, baby, sweetie, and others are never acceptable ways to address a patient; it is demeaning and disrespectful to address older adults as if they were children.REF: p. 59
Which statement is an example of open-ended nurse-patient communication? A) "What is your current pain level on a 1-10 scale at this time?" B) "Tell me what you understand about your upcoming surgery." C) "I need you to consider what the health care provider said when you spoke." D) "You must not worry so much; the health care provider is a very good provider."
B) "Tell me what you understand about your upcoming surgery." Saying, "Tell me what you understand about your upcoming surgery" is an open-ended statement. Asking the patient about his or her current pain level is focusing or a focused assessment. Telling the patient, "I need you to consider what the health care provider said when you spoke," or "You must not worry so much because the health care provider is a very good provider" are examples of giving advice, false reassurance, and commanding the patient. (REF p. 62-63, Table 5-2)
The nursing student is reviewing his interaction with a patient. He finds that he has used all of these communication techniques. Which one is considered nontherapeutic? A) Reflecting B) Commanding C) Silence D) Clarification
B) Commanding Commanding is a nontherapeutic communication technique. It is directing a client to do something that creates a power struggle or resistance. Reflecting, silence, and clarification are all examples of therapeutic communication techniques.
An LPN hears another nurse tell the patient, "You must lose 20 pounds immediately." Which description most accurately describes the communication style of the other nurse? A) Offered a personal opinion about which the patient should not be concerned B) Directed the patient to do something that creates a power struggle C) Offered advice without first encouraging the patient to explore his or her feelings D) Made a remark that discouraged patient communication
B) Directed the patient to do something that creates a power struggle Commanding means that the nurse directs the patient to do something that creates a power struggle or resistance. False reassurance means that the nurse inappropriately offers a personal opinion about which the patient should not be concerned. Premature advice means that the nurse offers advice without first encouraging the patient to explore his or her feelings fully. The problem must be explored carefully and potential actions considered before the patient can make a good decision. Communication cut-off means that the nurse makes a remark that discourages patient communication. REF: p. 63
The student nurse tells the patient that she will be going out tonight with her boyfriend. The student's communication can best be considered what? A) Therapeutic B) Nontherapeutic C) Focusing upon the patient D) Trying to get the patient's mind off his or her problems
B) Nontherapeutic The student's communication is considered nontherapeutic as it represents unprofessional communication that oversteps the boundary between nurse-patient communications. Trying to get the patient's mind off his or her problems and focusing upon the patient would also overstep the boundaries in nurse-patient communication. (REF pg. 62)
A patient has just revealed to the nurse, "My doctor says I have emphysema." Which statement or action is an example of therapeutic communication? A) "With that kind of diagnosis, you must quit smoking today." B) Sitting quietly and expectantly when the patient is speaking. C) "Everything will be fine. Don't worry; your doctor is very competent." D) "Try to think positively. New medications are being developed for this."
B) Sitting quietly and expectantly when the patient is speaking. Silence is a therapeutic communication technique. Telling the patient to stop smoking is commanding the patient. Telling the patient everything will be fine is providing false reassurance. Encouraging the patient to think positively is a communication cutoff.REF: pp. 61-64
An LPN is talking with a patient and chooses to review the subject matter that the patient has discussed. Which therapeutic communication technique is best in this case? A) Reflecting B) Summarizing C) Restating D) Clarifying
B) Summarizing Summarizing means that the nurse reviews the subject matter that the patient has discussed, which ensures common understanding between the nurse and patient. Reflecting means that the nurse "mirrors" back to the patient what the nurse has heard the patient say and allows the patient to confirm whether he or she was understood. Restating means that the nurse repeats information in his or her own words to ensure that the patient can confirm the nurse's interpretation. Clarifying means that the nurse seeks additional information to achieve a better understanding of the patient's meaning. REF: p. 63
An elderly woman who speaks only Spanish is being admitted to the hospital. Her daughter assures the staff that she can interpret for her mother. What is the most appropriate response by the nurse? A) "We do not allow family members to act as interpreters." B) "In that case, I will not request our staff interpreter." C) "We must provide a trained interpreter for some conversations." D) "You will need to stay here around the clock to interpret for her."
C) "We must provide a trained interpreter for some conversations." The most appropriate response by the nurse is that the hospital must provide a trained interpreter for some conversations. Nonmedical personnel and family members may not correctly relay information between the nurse and the client. An official, trained interpreter should be used to convey health information or obtain informed consent, because failure to do so has been identified as a factor in errors made in the health care system. The nurse should never accede to a family member's desire to be the sole interpreter. The staff interpreter is always called. Family members should be encouraged to interpret for other matters in order to help make the client more comfortable in strange surroundings. The family member is not required to stay at the health care facility around the clock.
In which year did the American Hospital Association issue a Patient's Bill of Rights that outlines the rights of hospital patients and incorporates the components of quality care? A) 1953 B) 1963 C) 1973 D) 1983
C) 1973 In 1973, the American Hospital Association issued a Patient's Bill of Rights that outlined the rights of hospital patients and incorporated the components of quality care. (REF pg. 59)
A patient states that he is, "very concerned about the length of recovery," after his upcoming surgery. The nurse replies, "Do you feel upset about the length of recovery?" The nurse is using which communication technique? A) Silence B) Reflection C) Clarification D) Summarizing
C) Clarification Clarification means seeking additional information to better understand the patient's meaning. Silence means waiting attentively while the patient speaks or thinks. Reflection mirrors back to the patient what the nurse heard him or her say. Summarizing reviews the subject matter that the patient discussed. (REF pg. 63, Table 5-2)
A facility where the LPN is employed must have bilingual individuals throughout the hospital who are trained in interpretation. The facility also needs a roster maintained to enable interpreters to be contacted as needed. Which option for oral language assistance would be best for this facility? A) Remote simultaneous interpretation B) Community interpreter banks C) Employee language banks D) Contract interpreters
C) Employee language banks In employee language banks, bilingual individuals throughout the facility are trained in interpretation with a roster maintained to enable interpreters to be contacted when needed. Remote simultaneous interpretation uses wireless remote headsets by the patient and the health care provider with an interpreter providing simultaneous interpreting. In community interpreter banks, independent agencies maintain lists of trained interpreters in the community with services available to any agency or business. Contract interpreters use professional interpreters who are employed only as needed and are useful for languages that are not commonly encountered in the setting. REF: p. 64
The nurse is in the role of a helping person. Which statement is correct for the nurse as helper? A) May keep secrets B) Meet each other's needs C) Meets the patient's needs D) Tries to influence each other
C) Meets the patient's needs The objective of the nurse-helper role is to meet the patient's needs. Nurses do not keep secrets because it interferes with the plan of care. The nurse-patient relationship does not involve the nurse and the patient meeting each other's needs. Accepting the patient's decision, rather than influencing each other, demonstrates respect of the patient's value system.
Why is it important for patients to be partners in their care? A) Patients follow what they are told to do. B) Patients and nurses can trust each other. C) Patients accept responsibility for their care. D) Patients respect nurses as they provide care.
C) Patients accept responsibility for their care. Patients must accept responsibility for their care. Patients must partner with their health care providers. This is in keeping with the Patient's Bill of Rights. Patients following what they are told to do, patients and nurses trusting each other, and patients respecting nurses as they provide care are not emblematic of a nurse-patient partnership but are akin to a patient as a docile individual that does not participate in his or her care. (REF p. 60)
A licensed practical nurse (LPN) observes another nurse attempting to influence a patient to the nurse's way of thinking. What should be the HIGHEST priority action on the part of the LPN? A) Do nothing. Influencing a patient is an appropriate part of the helping relationship. B) Monitor the nurse and patient closely for evidence of appropriate interaction. C) Speak with the nurse about interacting with the patient on a friend level. D) Encourage the nurse to continue to interact in this manner because doing so is therapeutic.
C) Speak with the nurse about interacting with the patient on a friend level. A friend would appropriately try to influence another in discussing various issues, whereas a nurse in the helping relationship would not attempt to influence a patient to the nurse's way of thinking. Doing nothing, monitoring the nurse, and encouraging the nurse are inappropriate manners of interaction. REF: p. 61
While collecting data during admission of a new patient, the nurse asked the questions below. Which is the best example of an open-ended question? A) "How many children do you have?" B) "How many hours do you sleep at night?" C) "How long have you been taking thyroid replacement drugs?" D) "Are you nervous about surgery?"
D) "Are you nervous about surgery?" An open-ended statement or question requires more than a "yes-or-no" or a short answer. The question, "Are you nervous about surgery?", leaves the client room to expound, to spend time offering his or her interpretation of nervousness, and discuss how such a feeling applies to his or her situation. "How many children do you have?" requires a specific answer of one or two syllables. "How many hours do you sleep at night?" is the same kind of question: short answer and specific. "How long have you been taking thyroid replacement drugs?" is the same kind of question: short answer and specific.
Which statement by the nurse indicates a need for further teaching on self-awareness? A) "I know my strengths and limitations." B) "My past may affect my reactions to certain situations." C) "I need to examine my attitudes, feelings, beliefs, and opinions." D) "Congruency between my verbal and nonverbal communication is not important."
D) "Congruency between my verbal and nonverbal communication is not important." A nurse needs to be self-aware and explore and assess how areas may affect communication. Self-awareness involves knowledge, experience, values, beliefs, perceptions, strengths, and weaknesses. All of these can affect the therapeutic environment. Past unresolved experiences may be emotionally laden. Congruency of verbal and nonverbal communication is important because if they are not congruent, it sends a mixed message. (REF p. 58)
Which statement by the nurse indicates a need for further teaching on self-awareness? A) "I know my strengths and limitations." B) "My past may affect my reactions to certain situations." C) "I need to examine my attitudes, feelings, beliefs, and opinions." D) "Congruency between my verbal and nonverbal communication is not important."
D) "Congruency between my verbal and nonverbal communication is not important." A nurse needs to be self-aware and explore and assess how areas may affect communication. Self-awareness involves knowledge, experience, values, beliefs, perceptions, strengths, and weaknesses. All of these can affect the therapeutic environment. Past unresolved experiences may be emotionally laden. Congruency of verbal and nonverbal communication is important because if they are not congruent, it sends a mixed message.REF: pp. 58, 62
The nurse has provided instructions on the Patient's Bill of Rights to a new nurse employee. Which statement by the new nurse employee indicates a need for further teaching? A) "I should call the patient by his or her full name." B) "I should not refer to my patient by room number." C) "I need to be sure to correctly pronounce my patient's name." D) "I address the patient as I hear the family members and friends addressing him or her."
D) "I address the patient as I hear the family members and friends addressing him or her." The patient should be referred to by his or her full name unless given permission to use the first name, even if visitors are using his or her first name. Referring to the patient by his or her name instead of room number conveys respect. Correctly pronouncing a patient's name also conveys respect. (REF pg. 59)
The nurse is instructing a new nurse employee on ways to develop a therapeutic relationship with a patient. Which statement by the new nurse employee indicates a need for further teaching on the concept of a therapeutic relationship? A) "I need to be open and honest with my patient." B) "I need to focus the conversation on my patient." C) "I should encourage my patient to share personal stories." D) "I can share stories about how I spent the weekend with my patient."
D) "I can share stories about how I spent the weekend with my patient." Self-disclosure is the sharing of personal information. It should be used rarely and only when it helps the patient. Telling the patient how the nurse spent the weekend is not therapeutic. Nurses need to be open and honest with their patients. The conversation needs to focus on the patient. Having the patient share personal stories is a way to build rapport and trust with the patient. (REF pg. 60-61)
All of these statements were made by the nurse when providing morning care to a patient. Which is the most likely to facilitate therapeutic communication with a patient? A) "Are you in pain now?" B) "I am preparing for my daughter's wedding." C) "There is nothing to worry about." D) "I was nervous before my surgery too."
D) "I was nervous before my surgery too." Therapeutic communication is appropriate to help the health care provider work toward the goal of relaxing the client and making the client better prepared for treatment. To state that "I was nervous before my surgery too," allows the nurse to demonstrate empathy with the client and to work into a means of sharing a common experience directly relevant to the client. "Are you in pain now?" is a question related to nursing care and does not lead to the goal of helping the client prepare for surgery. "I am preparing for my daughter's wedding" is a sharing by the nurse that has no therapeutic value. "There is nothing to worry about" is an empty statement that both know to be inaccurate and that may make the client more nervous than before.
The nurse is caring for a patient who tells the nurse she just learned she has been diagnosed with terminal cancer. To cultivate a therapeutic relationship, what is the nurse's best response? A) "Oh my; I had no idea." B) "Your husband must be so upset." C) "I will schedule a terminal cancer support group for you." D) "I will sit with you for a while; we can talk if you would like."
D) "I will sit with you for a while; we can talk if you would like." Offering to sit with the patient cultivates a therapeutic relationship by focusing on the patient and offering self. The response, "Oh, my; I had no idea," turns the focus to the nurse. Discussing the husband turns the focus to the husband and away from the patient. Although it may be appropriate at some point to set up supportive services for the patient, it is not appropriate at this time.REF: pp. 57, 58, 60-62
When the nurse approaches a patient and states, "You must think positively about the upcoming surgery," the nurse is demonstrating what type of communication technique? A) Reflecting B) Summarizing C) False encouragement D) Communication cutoff
D) Communication cutoff Stating, "You must think positively about the upcoming surgery," discourages the patient from communicating and demonstrates communication cutoff. Reflecting and summarizing are examples of therapeutic communication that will encourage the patient to share feelings with the nurse. False encouragement is nontherapeutic and is typified by the statement, "Don't worry; everything will be alright." (REF p. 63, Table 5-2)
A patient has asked the nursing student for her number. The student declines in order to maintain a therapeutic, rather than a social, relationship. The main difference between social and therapeutic relationships is that therapeutic relationships: A) Focus on both the patient and the nurse B) Are developed only in inpatient settings C) Help the nurse to work through personal problems D) Exist to meet patient-centered goals
D) Exist to meet patient-centered goals The primary difference between social and therapeutic relationships is that therapeutic relationships are goal oriented and focus on one individual - the client. Therapeutic relationships do not focus on both the nurse and the client. Therapeutic relationships may develop in inpatient settings, but may continue otherwise. Therapeutic relationships do not exist to help nurses work through personal problems.
The nurse is preparing to receive a newly admitted patient who is of a different ethnicity from the nurse for the first time. What is the first action the nurse must take to establish a therapeutic nurse-patient relationship? A) Review the patient's health history to better structure the interaction. B) Research the patient's ethnicity to know the best way to communicate with the patient. C) Greet the patient respectfully upon walking into the patient's room to set the tone for the interview. D) Explore the nurse's own views of the ethnic group to determine the ability to communicate with the patient.
D) Explore the nurse's own views of the ethnic group to determine the ability to communicate with the patient. In order to establish a therapeutic nurse-patient relationship, the nurse must first become self-aware of how one's own beliefs and values will affect the relationship. Although this is not the first action the nurse should take, it may be appropriate to research the patient's ethnicity to have a general idea of communication patterns. However, the nurse should not assume that the patient employs any or all of these patterns. If possible, it may be helpful to review the patient's medical record to know which questions to ask the patient, but this is not the first action the nurse should take. After exploring his or her own views and beliefs and how they will affect the relationship, the nurse should greet the patient respectfully as soon as he or she enters the patient's room. (REF pg. 57-58)
While a patient is describing a very traumatic accident, he is smiling and making jokes. This is an example of: A) Injury B) Deceitful communication C) False reassurance D) Incongruent actions and feelings E) Nontherapeutic communication technique
D) Incongruent actions and feelings Nonverbal actions can be in conflict with the content of what is being expressed verbally. This kind of incongruent communication can give clues to true feelings. An astute nurse should recognize that something is wrong in the face of this, even though the client may deny it verbally. Injury is trauma or other harm to the client. Deceitful communication is lying. The client may be telling the truth and still demonstrating incongruent behavior. False reassurance is another form of untruthfulness, where the client may be trying to reassure someone that there is no injury when there really is. This is not that situation. The behavior demonstrated here is also not nontherapeutic communication technique.
The nurse notes the patient is clutching the blanket. Which type of communication is this? A) Meta-communication B) Verbal communication C) Symbolic communication D) Nonverbal communication
D) Nonverbal communication The patient is demonstrating an action that is nonverbal yet conveys a message of concern. Meta-communication and symbolic communication are not by definition a nonverbal gesture. Both are demonstrated by a verbal statement along with nonverbal actions. The patient was clutching the blanket, which is not a verbal means of communication. (REF p. 61)
You are caring for an older adult who has been chronically ill for several years. The patient has decided to discontinue to discontinue life-sustaining treatment. You believe that life should be maintained at all costs. Which action best reflects acceptance of the patient in a therapeutic relationship? A) Asking the patient's family members to try to convince their loved one to continue treatment. B) Telling the patient that you believe that life is sacred and that it is wrong to refuse available treatment C) Telling your nurse manager you cannot continue to care for the patient who refuses treatment D) Planning with the patient ways to maintain quality of life for as long as possible
D) Planning with the patient ways to maintain quality of life for as long as possible Acceptance of the client in a therapeutic relationship must reflect focus on the client, not on the belief system of the nurse. Planning ways to maintain quality of life for the client for as long as possible indicates a nonjudgmental attitude of caring, which is appropriate in a therapeutic relationship. Avoiding the client and speaking to the family may violate confidentiality and may violate the Health Insurance Portability and Accountability Act and is not appropriate to a therapeutic relationship. Telling the client that it is wrong to refuse treatment attempts to insert attitudes opposed to those of the client and is not appropriate to a therapeutic relationship. Refusing to provide care for the client may constitute abandonment, demonstrates inadequate nursing care, and, again, is not appropriate to a therapeutic relationship
The nurse is supervising several certified nursing assistants (CNAs) who are interacting with patients. Which action is an example of inappropriate touch? A) Asking the patient permission to touch a hand when he or she is upset B) Offering to give a patient a back massage before the patient goes to sleep C) Holding a patient's hand while the patient experiences a period of anxiety D) Touching the patient's hand when he or she has pulled away from previous contact
D) Touching the patient's hand when he or she has pulled away from previous contact If the patient has pulled away from previous contact, such as holding the hand, this is an indication that the patient is uncomfortable with touch. The nurse should respect the patient's wishes in regards to touch. Asking the patient permission to touch a hand when he or she is upset, offering to give a patient a back massage before the patient goes to sleep, and holding a patient's hand during a period of anxiety are all appropriate uses of touch. (REF pg. 61)
The nurse is caring for a 15-year-old patient who was admitted with diabetic ketoacidosis and subsequently diagnosed with type 1 diabetes. The nurse understands that a major issue that affects the patient's safety is compliance with treatment. What is the best way for the nurse to facilitate the patient's compliance with treatment? A) Send the patient to diabetes education classes while in the hospital. B) Educate the patient's parents on how to control the patient's diabetes. C) Provide the patient with detailed instructions on how to care for diabetes. D) Work with the family and interdisciplinary team to find a suitable time for a care planning meeting.
D) Work with the family and interdisciplinary team to find a suitable time for a care planning meeting. Diabetes is especially dangerous in teenagers because compliance is often poor. The best way to ensure compliance is to encourage the patient and family to attend the interdisciplinary team's care planning meeting. The team should work with the family to ensure all can attend the meeting. It may or may not be appropriate to send the patient to diabetes education classes while in the hospital. Although the nurse should educate the parents and the patient on how to care for the diabetes, the patient must be empowered to control the diabetes by participating in the planning of care. (REF p. 60)
The nurse is caring for a 15-year-old patient who was admitted with diabetic ketoacidosis and subsequently diagnosed with type 1 diabetes. The nurse understands that a major issue that affects the patient's safety is compliance with treatment. What is the best way for the nurse to facilitate the patient's compliance with treatment? A) Send the patient to diabetes education classes while in the hospital. B) Educate the patient's parents on how to control the patient's diabetes. C) Provide the patient with detailed instructions on how to care for diabetes. D) Work with the family and interdisciplinary team to find a suitable time for a care planning meeting.
D) Work with the family and interdisciplinary team to find a suitable time for a care planning meeting. Diabetes is especially dangerous in teenagers because their compliance is often poor. The best way to ensure compliance is to encourage the patient and family to attend the interdisciplinary team's care planning meeting. The team should work with the family to ensure all can attend the meeting. It may or may not be appropriate to send the patient to diabetes education classes while in the hospital. Although the nurse should educate the parents and the patient on how to care for the diabetes, the patient must be empowered to control the diabetes by participating in the planning of care.REF: p. 60
