NURS 212 Professional and therapeutic communication first exam

The charge nurse informs a staff nurse that it is her turn to float to another unit. Which response by the staff nurse is aggressive? A. "I had such a bad experience last time. Please send another nurse instead of me." B. "I will miss working with you today, but I understand that it is my turn to float." C. "I will not survive on the other unit. The staff are always too busy to help me." D. "I will float, but you'll be sorry. You cannot handle emergencies without me."

"I will float, but you'll be sorry. You cannot handle emergencies without me." An aggressive response is forceful and confrontational; the person using an aggressive approach will place his or her needs first and respect for others is lacking. A nonassertive response is apologetic; the person frequently puts himself or herself down. An assertive response is clear, direct, confident, and honest.

An experienced nurse is supervising a student nurse in an acute care setting. Which statement, if made by the experienced nurse, would be most appropriate to help the student nurse establish credibility with other nurses on the unit? A. "It is impossible to be credible when you are a student because you lack experience." B. "Try to hide your feelings of inadequacy and portray a sense of confidence." C. "Be honest with the nurses about your strengths and about areas that need improvement." D. "It would help if you bring special treats for the nurses so that they will like you."

"Be honest with the nurses about your strengths and about areas that need improvement." Building of trust is the most important reason for being genuine; being genuine is important in gaining credibility with colleagues. An individual can be genuine and credible without extensive experience. Genuineness occurs when both verbal and nonverbal behaviors are congruent. Being liked is not equivalent to being genuine or being honest.

A nurse manager asks a colleague for advice on strategies to improve communication with staff nurses. Which response by the nurse manager's colleague is best? A. "Be sensitive, show respect, and be genuine." B. "You need to be consistently nice to the staff nurses." C. "Work as a staff nurse every month to develop empathy." D. "Staff nurses need a leader who is not emotional."

"Be sensitive, show respect, and be genuine." Improved communication with colleagues can be enhanced by expression of warmth. Warmth enhances closeness, creates a better work environment, and makes a colleague more approachable. A nurse manager needs to avoid insensitivity to co-workers and demonstrating aloofness and arrogance. Warmth, respect, genuineness, and empathy are needed to improve communication with colleagues. Being nice is not equivalent to expressing warmth. Empathy is not learned by performing the job of a colleague. Expression of warmth is an emotion.

A nurse manager offers a staff nurse a choice between working 8- or 12-hour shifts. Which statement, if made by the staff nurse, is nonassertive and may result in a frustrated response from the nurse manager? A. "I want to decide the shifts for all of the other staff nurses." B. "Do whatever you want. It doesn't really matter to me." C. "Thank you for offering me a choice. I prefer 12-hour shifts." D. "You will never be able to give me what I really want to work."

"Do whatever you want. It doesn't really matter to me." A statement that allows others to make decisions for a person is an example of a nonassertive style of communication; the response of others to a nonassertive statement may include disrespect, guilt, anger, or frustration. Statements that make choices for others or that are accusations are examples of aggressive styles of communication; the response of others to an aggressive statement may include hurt, defensiveness, or humiliation. A statement that allows making one's own decisions is an example of assertive style of communication; the response of others to an assertive statement may include mutual respect.

The nurse observes a student nurse who demonstrates nonverbal expressions that are cold and convey disinterest when caring for patients. Which statement, if made by the nurse, is best? A. "Patients will complain about you because your behaviors are unprofessional." B. "Have you noticed that your patients do not like you very much?" C. "For the next few shifts, closely observe how I display warmth to patients." D. "You need to change your behavior when interacting with your patients."

"For the next few shifts, closely observe how I display warmth to patients." The nurse should recommend an exercise that will help the student nurse identify nonverbal behaviors that convey warmth before the student nurse observes or changes his or her own behaviors. The term "unprofessional" indicates conduct, behavior, or language that is not befitting to a profession. The nurse should help the student nurse to recognize nonverbal behaviors that convey warmth instead of focusing on consequences (i.e., patient complaints) or likeability. Telling the student nurse to change behavior is not helpful; the nurse should initially focus on helping the student to identify behaviors that display warmth.

The nurse manager asks the staff nurse to work an extra shift. Which response by the staff nurse is assertive and based on rational beliefs? A. "I don't want you upset, so I will work extra." B. "Why do I always have to cover extra shifts?" C. "I am not able to work an extra shift." D. "If you can't find anyone else, I will do it."

"I am not able to work an extra shift." The staff nurse may turn down even a reasonable request; an assertive response avoids irrational beliefs. Irrational beliefs occur as a result of being anxious about assertiveness or focusing on possible negative outcomes.

The nurse cares for a client who does not follow dietary recommendations for treatment of heart failure. Which statement, if made by the nurse, demonstrates respect for the client? A. "It doesn't make any difference to me whether you decide to eat healthy or not." B. "You will get more attention from your physician, if you follow diet restrictions." C. "I care about you even if you are not following your dietary restrictions." D. "Have you noticed that patients who eat healthy foods receive better healthcare?"

"I care about you even if you are not following your dietary restrictions." The nurse demonstrates respect by giving unconditional acceptance of the client's ideas, feelings, and experiences without conditions. The nurse demonstrates respect with statements that convey caring; respectful statements make the client feel important and valued. The nurse is not demonstrating respect if conditions for acceptance (i.e., "more attention" or "better healthcare") are required.

The nurse cares for a client with abdominal pain who is scheduled for exploratory surgery. Which statement(s), if made by the nurse, indicates that the client's rights in the helping relationship have been violated? (Select all that apply) A. "I do not have time right now to help you call your family." B. "I am available to answer questions that you may have about your surgery." C. "You seem frightened. I will stay with you until your family arrives." D. "Your neighbors called, and I told them that you will have surgery." E. "If you do not let me start your IV, I will not give you pain medication."

"I do not have time right now to help you call your family." "Your neighbors called, and I told them that you will have surgery." "If you do not let me start your IV, I will not give you pain medication." Client rights that were violated are: (1) to secure help conveniently, without hassles or roadblocks; (2) to trust that the confidentiality of any personal information will be respected; and (3) to refuse or consent to nursing treatments without jeopardizing their relationship with their nurses. Client rights that were respected are: (1) to be informed about their health status and have all their questions answered so that they clearly understand what nurses mean and (2) to feel confident that they will be treated courteously and that their nurses show genuine interest in them.

The nurse cares for a patient who has type 2 diabetes mellitus and does not consistently follow the dietary restrictions and exercise recommendations. The patient takes a daily oral hypoglycemic agent as prescribed. Which statement by the nurse is most appropriate? A. "It is great that you take your medicine as prescribed." B. "It wouldn't be that hard to walk a few blocks every other day." C. "You are definitely not one of my good patients." D. "It is a waste of time to help you because you will never change."

"It is great that you take your medicine as prescribed." There are guidelines for nurse conduct in client-nurse helping relationships. The nurse should praise and encourage clients in their efforts to take better care of themselves. The nurse should not patronize clients, pigeonhole clients with labels (e.g., good, lazy, or uncooperative), or put down clients by making them feel inadequate or estranged.

The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse? A. "I will help you remember where your room is located." B. "Would you like me to read from your Bible today?" C. "Tell me a story about when you were young." D. "Sweetie, I will bring your coffee in a few minutes."

"Sweetie, I will bring your coffee in a few minutes." The elderly should not be addressed using disrespectful terms such as "honey," "sweetheart," "gramps," and "granny" and other patronizing forms of speech. Short-term memory may decline with age; healthcare providers may assist patients as needed. The elderly may express their spirituality through prayer and reading the Bible. Sharing stories helps an elderly patient to review life and establish meaning.

A patient is irritable and complains to the nurse about difficulty sleeping last night. Which response by the nurse is most appropriate? A. "I know you will sleep better tonight." B. "Tell me more about what happened last night." C. "Did you drink too much caffeine yesterday?" D. "No one sleeps well in the hospital."

"Tell me more about what happened last night." Kindness and warmth in health caring relationships are important to customer service. Responses that demonstrate warmth (i.e., "Tell me about your concerns") are important when a patient makes a complaint. Non therapeutic responses that do not convey warmth include reassurance (i.e., "I know you will sleep better tonight"); failure to probe (i.e., "Did you drink too much caffeine yesterday?"); and making stereotyped responses (i.e., "No one sleeps well in the hospital").

The nurse plans to delegate a client's personal hygiene to a nursing assistant. Which statement if made by the nurse to the nursing assistant is assertive? A. "Would you mind helping the client with a bath when you have time? If not, I will skip my lunch and do it myself." B. "You never get your work done and are always on the phone. You need to help the client right now with a bath, or I will write you up." C. "The client needs help with bathing. I want you to assist the client now, and you can go to lunch when you are finished." D. "I have important work to complete this morning. You will assist the client with a bath. Do not take a break until you have finished."

"The client needs help with bathing. I want you to assist the client now, and you can go to lunch when you are finished." An assertive statement is clear, direct, and respectful; the nurse should use assertive rights, avoid irrational beliefs, and use the Describe Express Specify Consequence script to formulate an assertive response. Describe: "The client needs help with bathing."Express and Specify: "I want you to assist the client now."Consequence: "You can go to lunch when you are finished."The other statements are nonassertive or aggressive:" Would you mind helping the client with a bath when you have time? If not, I will skip my lunch and do it myself." is nonassertive, hesitant, and apologetic."You never get your work done and are always on the phone. You need to help the client right now with a bath, or I will write you up." is aggressive, blaming, and negative."I have important work to complete this morning. You will assist the client with a bath. Do not take a break until you have finished." is aggressive, sarcastic, uncaring, and superior.

1. Which statement describes the effective aspect of learning effective communication strategies? A. "The nurse should use clear, direct statements using objective words." B. "The nurse uses body language that is congruent with the verbal message." C. "The nurse believes that positive communication strategies build confidence." D. "The nurse practices assertive and responsible communication strategies."

"The nurse believes that positive communication strategies build confidence." Learning involves three domains: the cognitive aspects (understanding and meaning), affective aspects (feelings, values, and attitudes), and psychomotor aspects (physical capability). Learning basic communication skills involves the cognitive domain; building confidence through a belief in the value and impact of positive communication is the affective domain; and putting skills into action is the psychomotor domain.

A client has high blood pressure and needs to learn about a low-sodium diet. Which question if asked by the client would be an indirect request for information? A. "How should I prepare food without adding salt?" B. "What will I do to make food taste better?" C. "What diet changes are needed to control my blood pressure?" D. "What foods should I avoid that are high in sodium?"

"What will I do to make food taste better?" Indirect requests for information are not obvious, and the meaning must be interpreted by the nurse. "What will I do to make food taste better?" is an indirect request for information; the nurse must interpret this question as a request for information about a low-sodium diet. The other questions are direct requests for information on a low-sodium diet.

The home care nurse visits a mother and her newborn 2 days after discharge from the hospital. The mother states, "My baby cries all the time. I must not be a very good mother." Which response by the nurse is nontherapeutic? A. "It sounds as if you are concerned about your ability to care for your baby." B. "The nurse moves closer to the mother and places a hand on her shoulder." C. "You just need to get away for a few hours. Find a babysitter and go to a movie." D. "I am not sure that I understand what you mean. Tell me more about how you feel."

"You just need to get away for a few hours. Find a babysitter and go to a movie." Giving advice (i.e., declaring to the patient what the nurse thinks) negates the worth of the patient as a mutual partner in decision making and is a nontherapeutic communication technique. Restating is repetition to the client of what the nurse believes is the main thought or idea expressed; restating asks for validation of the nurse's interpretation of the message. Reducing distance between the nurse and the client nonverbally communicates that the nurse wants to be involved with the client. Seeking clarification demonstrates the nurse's desire to understand the client's communication.

A patient reports to the nurse, "My doctor is not doing anything about my pain." Which response by the nurse is assertive and expresses warmth? A. "If I were you, I would see a different doctor." B. "What you really mean is you do not like your doctor." C. "It is wrong for you to blame your doctor." D. "You seem frustrated with your doctor."

"You seem frustrated with your doctor." An assertive statement that expresses warmth (i.e., "You seem frustrated with your doctor") engages in direct, fair confrontation with clear, honest statement of feelings; when the nurse conveys warmth and is assertive, a position of "I'm OK, you're OK" is assumed. Aggressive statements that lack expression of warmth include outright assaults or accusations (i.e., "It is wrong for you to blame your doctor"), making decisions for others (i.e., "If I were you, I would see a different doctor"), and labeling the other person (i.e., "What you really mean is you do not like your doctor").

The nurse cares for a patient with urinary incontinence after a stroke. Which response by the nurse is best? A. "You seem upset about this. We can work together on a bladder retraining program." B. "I don't mind cleaning up your mess. I am used to it because my child does this at night." C. "Don't be embarrassed. A lot of patients have this problem after a stroke." D. "I will bring you some diapers to wear instead of having you wet the bed all the time."

"You seem upset about this. We can work together on a bladder retraining program." The nurse must consider the client's self-esteem and preserve the client's dignity. Clients want to preserve or manage their image of self or "face." How the nurse handles a situation can influence the client's willingness to problem-solve.

The nurse cares for a patient who has just been diagnosed with lung cancer. Which statement by the nurse is therapeutic? A. "You sound really frightened about your diagnosis of cancer." B. "You will get better because the treatment will be started this week." C. "I think you should take a vacation and try to forget about the cancer." D. "An apple a day will keep the doctor away."

"You sound really frightened about your diagnosis of cancer." Reflecting helps the patient to clarify feelings and is a therapeutic communication technique. Reassuring (i.e., "you will be okay") negates fears and feelings of the patient. Getting advice (i.e., declaration to the patient of what the nurse thinks) negates the worth of the patient as a mutual partner in decision making. Making stereotyped responses (i.e., trite, meaningless verbal expressions) negates the significance of the patient's communication.

Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse? A. A 19-year-old white female patient who is standing 2 feet in front of the nurse. B. A 40-year-old African-American male patient who is sitting next to the nurse. C. A 60-year-old Latin-American female patient who is seated across from the nurse. D. An 82-year-old patient from France who is lying in bed with the nurse sitting next to the bed.

A 19-year-old white female patient who is standing 2 feet in front of the nurse. Different cultures prefer different degrees of closeness in personal space. Optimal distance for a therapeutic conversation is usually 3 to 4 feet. Generally, middle-class Americans feel uncomfortable when standing close to people they do not know well. Latin Americans, African Americans, and the French welcome physical closeness. In most cultures, men need more space than women do. Usually people will tolerate a person standing close to them at their side more readily than directly in front of them. Direct eye contact usually requires more space. Placing oneself at the same level (e.g., sitting while the client is sitting or standing at eye level when the client is standing) is usually perceived as less threatening. Nurses should sit at eye level with bedridden clients.

It would be most important for the nurse to temporarily withdraw expressions of warmth to which patient? A. A 20-year-old patient who is angry and throwing objects. B. A 32-year-old patient who is withdrawn and refuses nursing care. C. A 48-year-old patient who is extremely anxious about surgery. D. A 56-year-old patient who has a history of violent behavior.

A 20-year-old patient who is angry and throwing objects. When the nurse feels hurt, bitter, irritated, or enraged with a patient, trying to convey warmth would be insincere. It would be appropriate to express warmth to patients who are withdrawn and anxious. Expression of warmth is appropriate for a patient with a history of violence; the patient is not exhibiting the violent behavior at this time.

Which individual is displaying thoughts or actions that are genuine? A. A nurse who advocates for clients in order to qualify for a raise in personal hourly pay. B. A nurse who takes action to increase awareness of the need for cultural sensitivity. C. A nurse who supports a change in a project in front of supervisors but complains to staff. D. A nurse who verbally supports a new policy but does not follow the policy in practice.

A nurse who takes action to increase awareness of the need for cultural sensitivity. Expression of genuine thoughts and feelings about issues results in clear messages to clients and colleagues. Genuineness has positive therapeutic outcomes. When a mismatch exists between nurses' thoughts and feelings and actions, falseness or deceit occurs.

As an experienced staff nurse, you have been asked to create a teaching guide for nursing orientation on respect. Accessing the list from Ehow about being genuine, you would include all of the following. (Select all that apply) A. Acting natural around others B. Listening when others are speaking C. Denying your mistakes D. Compliment only when you sincerely mean it E. Lying to make friends F. Skipping invitations to event you wouldn't genuinely enjoy

Acting natural around others Listening when others are speaking Compliment only when you sincerely mean it Skipping invitations to event you wouldn't genuinely enjoy According to the Ehow link provided on "How to Be Genuine," these were some of the recommendations: acting natural around others, listening when others are speaking, admitting when you have made a serious mistake, complimenting only when you sincerely mean it, avoiding lying just to make friends, and skipping invitations for any event that you simply wouldn't enjoy.

The nurse is performing a well-child assessment on a 15-month-old child. The child's mother and father are present. Which action by the nurse will best determine the health beliefs and values of the parents? A. Have the parents independently complete the Myers-Briggs Type Indicator survey. B. Read the documented health histories of the child's parents and grandparents. C. Actively listen to the parents talk about their lives and health concerns. D. Review the traditional health practices of the ethnic group identified by the parents.

Actively listen to the parents talk about their lives and health concerns. Nurses should listen to their client's story to gain insight and knowledge into how a person defines "health." The Myers-Briggs Type Indicator identifies a person's preferences in regard to perception and judgment. Review of health histories or traditional health practices will not provide as much insight on health beliefs and values as allowing the client to tell his or her story.

The nurse cares for a young adult patient in the emergency room after a sexual assault. Which action by the nurse is appropriate? A. Avoid situations in which the patient will be involved with decision making. B. Tell the patient to join a local support group for sexual assault victims. C. Actively listen to the patient express feelings related to the sexual assault. D. Provide detailed information about evidence collection and invasive procedures.

Actively listen to the patient express feelings related to the sexual assault. The nurse should exhibit polite behaviors when interacting with patients who are fearful, embarrassed, or angry. Polite behaviors lessen the threat of intimate or invasive nursing actions (e.g., questions about behavior, physical assessment, and treatments). Active listening is an example of polite behavior. When discussing a potentially embarrassing situation, the nurse should be careful about the language used and ask questions gently. Nurses may tactfully encourage the patient's participation in decision making and problem solving. Nurses should avoid a direct order (e.g., joining a support group) because it is considered impolite and inappropriate.

The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client? A. Review the predominant health beliefs of the Nigerian population. B. Appraise the client's health beliefs and behaviors with a cultural assessment. C. Consult with other nurses who have taken care of clients from other countries. D. Use standard communication techniques to establish a helping relationship.

Appraise the client's health beliefs and behaviors with a cultural assessment. Tripp-Reimer and Afifi (1989) suggest two processes that nurses may use to communicate with clients from diverse cultures: cultural assessment and cultural negotiation. Cultural assessment refers to the appraisal of a client's health beliefs and behaviors. The information is then used to determine appropriate nursing interventions. Cultural negotiation refers to the process of negotiating with the client regarding differences in the lay and professional belief systems concerning appropriate care. Information obtained from other sources (e.g., written documents, other nurses, experts, and standards) is not specific to this client's health beliefs and behaviors.

The home health nurse visits a client with heart failure who has increased dyspnea and peripheral edema and weight gain. The nurse suspects the client is not restricting fluids as prescribed. Which action by the nurse is most appropriate? A. Teach the client about the consequences of not following the fluid restrictions. B. Ask the client to report the amount of fluid intake for the past 24 hours. C. Provide the client with sugarless candy or gum to decrease the thirst sensation. D. Consult with the healthcare provider about increasing the dose of the diuretic.

Ask the client to report the amount of fluid intake for the past 24 hours. Client validation of the assessment data leads to mutual problem-solving with the nurse. Incorporating validation keeps nurses focused on the rights and obligations of clients to make their own decisions about their health. Validation means consciously seeking out the client's opinions and feelings, unearthing questions or concerns related to plans for their healthcare, and securing an understanding and willingness to proceed to the next step. Incorporating validation into problem-solving ensures that the nurse obtains complete agreement and commitment from the client about the nursing care plan.

The nurse cares for a patient who is scheduled for abdominal surgery. Which action, if taken by the nurse, is most appropriate? A. Mandate the use of a complementary therapy such as guided imagery. B. Administer opioids for pain rated more than 3 (on a 0 to 10 pain scale). C. Ask the patient about expectations for postoperative pain management. D. Provide pain management based on a standardized nursing care plan.

Ask the patient about expectations for postoperative pain management. The nurse in collaboration with the patient should set priorities and determine expected and desired outcomes related to management of pain after surgery. Interventions to manage postoperative pain should be discussed with the patient. The patient and nurse should collaborate and determine appropriate pain management interventions. In addition, the pain management interventions should be individualized for each patient.

The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate? A. Use both first and last name with each encounter. B. Ask the patient how he prefers to be addressed. C. Call the patient by his first name. D. Address the patient by his last name.

Ask the patient how he prefers to be addressed. It is important to call the patient by the name he or she prefers. The nurse should ask a person how he or she prefers to be addressed because considerable cultural variation exists. Most Americans are comfortable with calling people by their first names. This is perceived by some, however, as a failure to show respect.

The nurse is providing care to a patient who was admitted with heart failure. The patient has not been following the prescribed diet or taking the prescribed medications. Which type of communication approach is most important for the nurse to use with this patient to facilitate a change in self-care behavior? A. Authoritative, honest, and outright communication B. Assertive, responsible, and caring communication C. Aggressive, sympathetic, and realistic communication D. Positive, expert, and focused communication

Assertive, responsible, and caring communication Communication must be technically responsible, assertive, and caring to facilitate a change in behavior.

The nurse is interviewing a Native American client. It is most important for the nurse to take which action? A. Maintain eye contact to show respect and interest. B. Assess whether the client is comfortable with eye contact. C. Avoid prolonged eye contact with this client. D. Sit next to the patient to avoid any eye contact.

Assess whether the client is comfortable with eye contact. Eye contact is often cultural; some Native Americans believe that prolonged eye contact is rude and intrusive. However, it is important to assess each individual patient for preferences and comfort with eye contact.

Which describes characteristics of mutuality in the nurse-client relationship? (Select all that apply) A. Dependency B. Collaboration C. Paternalism D. Acceptance of differences E. Empathy

Collaboration Acceptance of differences Empathy Mutuality is characterized by empathy, collaboration, and equality (i.e., acceptance of differences). Mutuality is characterized by interdependency, not dependency. Paternalism is the practice of managing or governing other individuals; shared decision making is a characteristic of mutuality.

As a part of the F.O.C.U.S. model, the "C" stands for A. Communicate B. Connect C. Concern D. Convince

Connect According to the author, F.O.C.U.S. is a model she created to help nurses connect with the current moment in which they are serving. The model contains the following elements: Feel, Observe, Connect, Understand, and Share.

The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about delivering care to diverse clients? A. Adopt a transcultural framework to develop culturally appropriate care. B. Ask clients about their personal healthcare beliefs. C. Develop a self-awareness of personal healthcare beliefs. D. Recognize ethnocentric beliefs of minorities in the community.

Develop a self-awareness of personal healthcare beliefs. The initial action that the nurse should take to learn about delivering care to diverse clients is to become familiar with personal healthcare beliefs and behaviors. Self- awareness helps nurses recognize that their beliefs and behaviors are not necessarily common to all. Nurses' lack of knowledge about their own culture can distort their perceptions of the beliefs and behaviors of clients from diverse cultures. Transcultural frameworks have been developed to help nurses provide culturally appropriate nursing care. Ethnocentrism interferes with the appreciation of diverse cultures and their healthcare beliefs and behaviors.

While admitting a patient to the medical unit, the nurse should take which action? A. Demonstrate human caring by hugging the patient for brief intervals. B. Disclose shared intimate details with other healthcare providers. C. Maintain a physical distance of at least 3 to 4 feet at all times. D. Develop the plan of care and measurable objectives with the patient.

Develop the plan of care and measurable objectives with the patient. The patient and nurse should develop the plan of care together; attainment of objectives should be evaluated with the patient. Nurses may have strong feelings for their patients and express caring, but the nurse should maintain adequate objectivity and perspective to provide therapeutic assistance. Patients should have a sense of privacy, and confidentiality should be maintained. The nurse should not share intimate patient details with others.

A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? A. Discover cultural influences on healthcare perceptions and behaviors. B. Assist the patients to adapt to American culture and health beliefs. C. Avoid confrontation of underlying issues of discrimination. D. Improve communication by learning how to speak Spanish.

Discover cultural influences on healthcare perceptions and behaviors. As our society becomes more global and diverse, cultural competence is a dynamic concept that must be evaluated continuously as it relates to patient outcomes (Waite et al., 2014). Nurses need to know about culture because it influences both nurses' and clients' healthcare perceptions and behaviors. Nurses should learn about the culture of diverse clients and communities. Nurses need to recognize and overcome certain attitudes basic to the American culture. To provide culturally competent care, the nurse must address issues of discrimination. Learning how to speak another language is important, but it is more important to seek understanding of cultural influences on health.

According to a study by Robinson (2014), three parts of our true presence (how we connect with patients) are found in being: A. Friendly, kind, and sweet B. Genuine, gifted, and creative C. Humorous, partial, and grateful D. Genuine, attentive, and immersed

Genuine, attentive, and immersed If we say a person is genuine, what does it mean? Why is it important to be "your natural self" in human relationships? We connect with patients by being genuine, attentive, and immersed in the moment with the person ... true presence (Robinson, 2014).

The nurse instructs a client who is diagnosed with hypertension about weight reduction and dietary guidelines. Which action by the nurse would most likely improve the client's willingness to lose weight and eat healthy foods? A. Avoid interacting with the client during meals to prevent embarrassment. B. Ignore the client's requests for foods that are high in fat or calories. C. Give genuine praise to the client for trying to improve dietary habits. D. Warn the client that individuals who are overweight will be treated differently.

Give genuine praise to the client for trying to improve dietary habits. Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is given when the nurse recognizes the client for efforts to improve health. The nurse who either avoids or ignores the client is demonstrating disrespectful behavior. Treating a client differently because of noncompliance is disrespectful.

The nurse cares for a female patient who is trying to gain understanding of her life and her diagnosis of metastatic breast cancer. Which approach by the nurse would best meet this patient's needs? A. Suggest the patient join a breast cancer support group. B. Provide the patient with reading material on death and dying. C. Contact the patient's spiritual leader to request daily visits. D. Listen to the patient's stories about her past experiences.

Listen to the patient's stories about her past experiences. Listening to the patient's story is an important assessment tool; the nurse can assess a patient's self-care knowledge and gain greater understanding of the patient. The nurse is able to learn what is important to the patient and create a personalized plan of care.

A nurse preceptor is assigned to help several graduate nurses assess their ability to convey warmth to patients. Which activity, if selected by the nurse preceptor, is best? A. Set up sessions for the graduate nurses to practice various nonverbal gestures. B. Ask the graduate nurses to record the behaviors of experienced nurses on the unit. C. Provide the graduate nurses with a list of nonverbal behaviors that convey warmth. D. Have the graduate nurses evaluate each other during simulated patient interviews.

Have the graduate nurses evaluate each other during simulated patient interviews. A simulated patient interview that is evaluated would provide the best opportunity for the graduate nurses to develop skills to assess warmth and to receive feedback on personal warmth skills. A list of nonverbal behaviors does not foster active learning. Nonverbal gesture practice does not help graduate nurses learn how to assess warmth skills with a patient. Recording nonverbal behaviors is observation and does not give the graduate nurses a specific experience in assessment of warmth skills.

The nurse cares for elderly clients in an assisted living center. Which action by the nurse would best show respect for these clients? A. Patronize clients who share ideas or voice concerns. B. Identify healthcare needs by listening to the clients. C. Address the clients formally by their last names. D. Limit the clients' opportunities to express opinions.

Identify healthcare needs by listening to the clients. The nurse shows respect by listening to clients discuss ideas, concerns, or healthcare needs. The nurse should not belittle, judge, demean, or patronize clients; these actions are disrespectful. The nurse demonstrates respect by asking the clients their preferences for being addressed; not all elderly clients want to be called by their last names. The nurse demonstrates respect by providing opportunities for the clients to express opinions.

Which demonstrates the nurse's genuine concern for clients? A. Tell a patient who has a terminal illness that everything will be fine. B. Delay notifying the patient about the death of a dependent child. C. Provide a placebo to a patient in severe pain to assess for substance abuse. D. Inform the patient about a medication error along with symptoms to report.

Inform the patient about a medication error along with symptoms to report. Genuineness is the presentation of one's true thoughts and feelings. Nurses should be genuine (or honest) when appropriate; honesty is appropriate if there is benefit to the patient (i.e., medication error with potential adverse effects). The nurse should not speak a falsehood (i.e., "everything will be fine") or withhold the truth (i.e., information about a child, placebo use).

The nurse makes a home visit to a client with chronic kidney disease. The client asks the nurse to make the decision about whether or not to start dialysis. Which action by the nurse is most appropriate? A. Encourage the client to appoint a durable power of attorney. B. Invite the client to make a decision after reviewing options. C. Direct the client to have the physician make a decision. D. Have the client visit with an individual receiving dialysis.

Invite the client to make a decision after reviewing options. Nurses should encourage clients to be active, responsible partners in their care; the nurse encourages a mutual problem-solving process by inviting or requesting the full participation of clients. A durable power of attorney can be authorized to make healthcare decisions if clients are no longer able to speak for themselves. Having the physician make decisions for the client places the client in a passive role. The client may visit with another person receiving dialysis, but the decision should be made by the client.

Which characteristic would the nurse use to define culture? (Select all that apply) A. Learned and shared lifeways of a particular group. B. Social identity influenced by language and religion. C. Belief in superiority of one's own ethnic group. D. Values influence both thinking and actions. E. Several generations share the same beliefs.

Learned and shared lifeways of a particular group. Values influence both thinking and actions. Several generations share the same beliefs. Culture is the learned and shared beliefs, values, and lifeways of a particular group that are generally transmitted intergenerationally and influence one's thinking and actions. Ethnicity refers to the social identity and origins of a social group due largely to language, religion, and national origin. Ethnocentrism is the universal tendency of people to believe that one's own race or ethnic group is the most important and/or that some or all aspects of its culture are superior to those of other groups.

The nurse is caring for a client who is diagnosed with type 1 diabetes mellitus. Which nursing action would most likely improve client compliance with the therapeutic regimen? A. Consistently ignore negative statements made by the client. B. Avoid touching the client to reduce tension and uneasiness. C. Focus on the physical aspects of care such as insulin administration. D. Listen attentively to the client's perception of having a chronic illness.

Listen attentively to the client's perception of having a chronic illness Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is communicated by giving the client undivided attention and listening to the client's perceptions. Other actions that demonstrate respect include appropriate contact by gently touching the client, listening to both positive and negative client statements without judgments, and giving attention to the client as a whole (body, mind, and spirit).

The home health nurse cares for a patient who is diagnosed with chronic obstructive pulmonary disease. Which response(s) and behavior(s) by the nurse would indicate that bonding between nurse and patient has occurred? (Select all that apply) A. Expects the patient to meet the goals for exercise as determined by the nurse. B. Listens to the patient describe the feelings of anxiety related to severe dyspnea. C. Develops teaching plan based on the learning preferences of the patient. D. Refrains from touching the patient unless performing physical assessment techniques. E. Requests that the patient wait to ask questions until the end of the home visit. F. Learns the names of the patient's family members and close friends and neighbors.

Listens to the patient describe the feelings of anxiety related to severe dyspnea. Develops teaching plan based on the learning preferences of the patient. Learns the names of the patient's family members and close friends and neighbors. Responses and behaviors of the nurse that indicate bonding between the nurse and the patient include listening to verbalization of the patient's feelings, asking for the patient's input on learning styles and needs, and listening to the patient talk about support persons. Other indicators (responses and behaviors by the nurse) of bonding include touching a patient for reassurance when appropriate, including the patient in the plan of care (and developing goals), and encouraging inquiries from the patient.

The nurse cares for an adult client who is diagnosed with active tuberculosis. Which action, if performed by the nurse during introductions, shows respect for the client? (Select all that apply) A. Maintain eye contact by looking at the client. B. Avoid touch to reduce transmission of the disease. C. Stay at least 4 to 6 feet away from the client. D. Briefly converse about the weather to break the ice. E. Determine how the client would like to be addressed.

Maintain eye contact by looking at the client. Briefly converse about the weather to break the ice. Determine how the client would like to be addressed Respect is demonstrated by acknowledgment. Actions during an introduction that show respect include looking at the client and maintaining eye contact, using a brief period of impersonal or trivial exchanges (such as the weather) to break the ice, or determining how the client likes to be addressed. The nurse can touch and move close to a patient with active tuberculosis if appropriate precautions are taken (i.e., airborne infection isolation and a high-efficiency particulate air mask).

According to Swanson's theory, there are five caring processes, one of which is "knowing." What are the other four? A. Communication, assertiveness, responsibility, and caring B. Maintaining belief, being with, doing for, and enabling C. Understanding, action, information, and comfort D. Maintaining belief, being with, enabling, and supporting

Maintaining belief, being with, doing for, and enabling Caring is an essential ingredient in life and must characterize the nurse-client relationship.... Consider Swanson's five caring processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally present to the other4) Doing for— doing for others what they would do for themselves if possible5) Enabling—facilitating the capacity of others to care for themselves and family members (Tonges and Ray, 2011, p. 375)

According to the ANA's Standards of Clinical Nursing Practice, there are several steps within the nursing process that surround patient care. However, one of the most important steps is the one in which the nurse partners with the patient, family, and other caregivers to create an acceptable path that meets the patient's needs and is specific to the disease process. This important step is identified as: A. Evaluation B. Planning C. Implementation D. Nursing diagnosis

Planning The standards set forth in Standards of Clinical Nursing Practice by the American Nurses Association (2010)—assessment, diagnosis, outcome identification, planning, implementation, and evaluation—provide support for a mutual problem-solving approach with clients. During planning, the registered nurse develops an individualized plan in partnership with the person, family, and others considering the person's characteristics (2010, p. 36).

Which facial feature, if displayed by the nurse, best conveys warmth? A. Small pupils and a fixed gaze B. Furrowed brow and a wrinkled forehead C. Pursed lips and a forced smile D. Relaxed muscles and a concerned expression

Relaxed muscles and a concerned expression Facial features that convey warmth include the following: (1) face moves in a relaxed, fluid way; worried, distracted, or fretful looks are absent; face shows interest and attentiveness; (2) pupils are dilated; gaze is neither fixed nor shifting and darting; (3) lips are loose and relaxed, not tight or pursed; smile is not forced, jaw is relaxed and mobile, not clenched; and (4) forehead muscles are relaxed, and forehead is smooth; there is no furrowing of the brow.

Which nonverbal action(s) would be consistent with an assertive style of communication? (Select all that apply) A. Relaxed posture B. Established eye contact C. Hands placed on hips D. Distant, soft voice E. Mask-like facial expression

Relaxed posture Established eye contact Assertive styles of communication that are nonverbal include a relaxed stance and eyes that are warm, in contact, and frank. Aggressive styles of communication that are nonverbal include expressionless, cold, narrowed, or staring eyes and hands placed on hips. A weak, distant, soft voice is a nonassertive style of nonverbal communication.

The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best? A. Ask a bilingual friend of the patient to interpret. B. Use nonverbal communication and draw pictures. C. Request a Spanish-speaking medical interpreter. D. Interview the patient's English-speaking daughter.

Request a Spanish-speaking medical interpreter. Professional interpreters are able to communicate medical terms and can be of assistance in reducing the risks of breaches in patient privacy and confidentiality. Also, information can be directly obtained from the patient. When family members or volunteers serve as the interpreter, patients are often uncomfortable sharing sensitive information. Family members in a stressful situation may have difficulty being the interpreter. Although nonverbal communication is important, this method should only be used if an interpreter is not available.

The nurse prepares to obtain a health history from a hospitalized patient. Which action by the nurse is appropriate? A. Set time limits for the interview to reduce cost. B. Avoid asking questions that may upset the patient. C. Respect the patient's privacy by closing the door. D. Stand at the foot of the bed to maintain eye contact.

Respect the patient's privacy by closing the door. The nurse should ensure privacy before engaging in a discussion of confidential matters when obtaining a health history. The nurse should allow for adequate time for the client to discuss the health history. The nurse must be able to discuss sensitive health issues with clients; the nurse should establish rapport and respectfully discuss sensitive subjects. The nurse should avoid standing over the patient; the nurse should be at eye level with the patient.

The nurse has implemented a plan to improve expression of warmth to other nurses. It is most important for the nurse to include which evaluation method? A. Self-monitor interactions with colleagues for feelings of relaxation and caring. B. Ask patients for their perception of the interactions that occur among nurses. C. Invite a supervisor to evaluate interactions and provide suggestions for improvement. D. Seek nominations for an award at the organizational level or from an association.

Self-monitor interactions with colleagues for feelings of relaxation and caring. One of the most important measures of warmth is the individual's inner feelings; the nurse should monitor for more relaxed, caring feelings toward others and for free-flowing affection and engagement with others. The patients would not be able to reliably evaluate interactions between nurses or other healthcare professionals. Specific feedback about warmth ability can be obtained by asking a colleague (or supervisor) to evaluate the interactions with colleagues and to let them provide constructive feedback. An award nomination is not a suggested evaluation method to measure warmth.

The nurse cares for a patient who has metastatic cancer. Which action(s) by the nurse conveys warmth? (Select all that apply) A. Avoid distracting actions such as hand gestures. B. Show interest by occasional head nodding. C. Lean forward toward the patient at a 45-degree angle. D. Place arms across the chest to prevent fidgeting. E. Sit or stand to keep eyes level with the patient's eyes.

Show interest by occasional head nodding. Sit or stand to keep eyes level with the patient's eyes. The nurse displays warmth by certain body postures. Body postures that convey warmth include the following: (1) the nurse's head should be kept at the same level as the client's head; (2) hand gestures should be natural, with no clenching or grasping of objects and avoiding distracting mannerisms; (3) arms are kept loose and able to move smoothly, rather than held stiffly; (4) periodic nodding shows interest and attentiveness; and (5) the chest should be kept open with slight forward leaning to show interest.

The nurse cares for a client who has several options for cancer treatment. Which document supports the client's right to have access to information about treatment options? A. The Standards of Clinical Practice B. An Advance Health Care Directive C. The Patient's Bill of Rights D. A Client's Living Will

The Patient's Bill of Rights The Patient's Bill of Rights (presented by the American Hospital Association) describes the expectations for respect, knowledge, privacy and confidentiality, and access to any information essential for adequate treatment. The Standards of Clinical Practice (by the American Nurses Association) provide standards for quality of care, diagnosis, outcome identification, planning, implementation, and evaluation. A Client's Living Will is a document that identifies healthcare preferences (related to care intended to sustain life) if the client is incapacitated. An Advance Health Care Directive is a legal document that indicates a client's wishes about healthcare.

A nurse openly and genuinely discusses thoughts and feelings about sexually transmitted infections with a group of college students. Which benefit(s) may occur for these college students? (Select all that apply) A. The college students are reluctant to continue discussions with the nurse. B. The college students develop a trusting relationship with the nurse. C. The college students question the nurse's credibility. D. The college students believe the information is reliable and accurate. E. The college students are able to express important concerns.

The college students develop a trusting relationship with the nurse. The college students believe the information is reliable and accurate. The college students are able to express important concerns. If a nurse is genuine, clients may benefit by (1) developing a feeling of trust for the nurse; (2) being able to express true thoughts and emotions; and (3) receiving helpful information that is credible.

According to Swanson's theory, there are five caring processes, one of which is "being with." Which of the responses by the nurse portrays an understanding of the concept of "being with" a client? A. The nurse charting in the room to spend more time with the client B. The nurse wearing locator badge so you can quickly respond any time patient would call front desk and ask to page you C. The nurse requesting one-on-one nurse staffing D. The nurse being emotionally present to the client

The nurse being emotionally present to the client Caring is an essential ingredient in life and must characterize the nurse-client relationship... Consider Swanson's five caring processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally present to the other4) Doing for— doing for others what they would do for themselves if possible5) Enabling—facilitating the capacity of others to care for themselves and family members (Tonges and Ray, 2011, p. 375)

Which are examples of a nurse who is communicating responsibly? (Select all that apply) A. The nurse uses profanity to respond to a client who is intoxicated and verbally abusive. B. The nurse helps a client talk to family members about discontinuing chemotherapy. C. The nurse uses interpersonal strategies to help a client develop methods of coping. D. The nurse provides a client's health information to a close relative who is visiting. E. The nurse listens carefully to the client's concern about inadequate pain relief.

The nurse helps a client talk to family members about discontinuing chemotherapy. The nurse uses interpersonal strategies to help a client develop methods of coping. The nurse listens carefully to the client's concern about inadequate pain relief. A nurse who communicates responsibly will perform the role of a client advocate, will consider the world of the client and the client's family, and will naturally focus on the nursing process and problem-solving process. The nurse is responsible for maintaining the professional conduct of the relationship. Examples of unprofessional conduct would include breaching client confidentiality or verbally abusing a client.

The nurse discusses smoking cessation with a client. Which action, if taken by the nurse, would most likely result in a behavior change? A. The nurse should advise the client to contact the national telephone quitline. B. The nurse should recommend nicotine replacement and behavioral interventions. C. The nurse should collaborate with the client to develop an individualized plan of action. D. The nurse should implement a strategy that has been validated by research.

The nurse should collaborate with the client to develop an individualized plan of action. The nurse should include validation in the nursing process; validation and collaboration with the client increase the probability of a successful change in behavior (e.g., smoking cessation). Specific interventions that are evidence based are appropriate, but the nurse should include the client in the nursing process or the problem-solving process.

The community health nurse is listening to a client talk about a personal problem. Which of these actions by the nurse is most appropriate? A. The nurse should increase the physical distance from the client. B. The nurse should lean toward the client and make eye contact. C. The nurse should periodically interrupt the client to ask questions. D. The nurse should initiate the physical assessment to distract the client.

The nurse should lean toward the client and make eye contact. To actively listen to a client, the nurse should use open body language, arms open—not crossed; make eye contact without staring; echo words or paraphrase facts and feelings; lean toward the person speaking; do not interrupt; pay attention; and try to relax.

The nurse cares for an adult client diagnosed with type 1 diabetes mellitus. Which is essential in building mutuality in the nurse-client relationship? A. The nurse controls the relationship by retaining the power to make judgments about diabetes education. B. The nurse teaches diabetes management by involving the client in making decisions about self care. C. The nurse has expert knowledge of diabetes and formulates appropriate learning outcomes for the client. D. The nurse demonstrates trust and respect by solving problems for the client when issues occur with self-management.

The nurse teaches diabetes management by involving the client in making decisions about self care. Mutuality is an essential element in building relationships with the client and is characterized by empathy, collaboration, equality, and interdependency. Mutuality is a sharing of collective knowledge and decision making.

The nurse cares for a client with hypertension, and a nurse-client contract is developed outlining the activities and responsibilities of each. Which would be appropriate to include in this contract? (Select all that apply) A. The outcomes should be realistic and measurable. B. Progress should be reviewed at regular intervals. C. The contract should be written and signed. D. The nurse should keep the information confidential. E. The nurse and client should mutually evaluate progress.

The outcomes should be realistic and measurable. Progress should be reviewed at regular intervals. The nurse and client should mutually evaluate progress. The contract should be realistic and spell out measurable behaviors. The nurse and client should mutually evaluate outcome achievement at regular intervals. The contract may be either verbal or written. The nurse should not promise to keep information confidential; nurses must share information that is important to the well-being of the client or others (e.g., plans to harm self or others).

A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective? A. Assume a subservient role to the physician. B. Use a direct approach with succinct sentences. C. Ask questions instead of making recommendations. D. Be polite and expect politeness from the physician.

Use a direct approach with succinct sentences. Simplicity of speech is recommended; use direct communication with few words. The nurse should not assume a subservient role to the physician; there needs to be a connection between communication, collaboration, and teamwork in the nurse-physician relationship to provide quality care. The nurse should be assertive, expect professional respect, and exude expertise.

According to the Workplace Bullying Institute, nurses are also exposed to this type of behavior within their professional environment. In teaching the possibility to an incoming graduate nurse, you know that the nurse understands when he or she includes which of the following as abusive conduct? (Select all that apply) A. Threats B. Humiliation C. Intimidation D. Physical abuse E. Sabotage

Threats Humiliation Intimidation Sabotage The Workplace Bullying Institute defines workplace bullying as "repeated, health harming mistreatment of one or more persons (the targets) by one or more perpetrators. It is abusive conduct, that is, threatening, humiliating or intimidating, workplace interference (sabotage), or verbal abuse (2014). Physical abuse would be assault.

The nurse cares for a client who is scheduled for a breast biopsy. Which is the main purpose of the client-nurse relationship? A. To develop a mutually satisfying experience for the client and nurse. B. To assist the client in achieving and maintaining optimal health. C. To provide excellent client service and improve quality of care. D. To allow the client to receive important health information.

To assist the client in achieving and maintaining optimal health. The client-nurse relationship is established primarily to help the client achieve and maintain optimal health. The client-nurse relationship is entered for the benefit of the client but is more effective if the relationship is mutually satisfying. The ability to communicate clearly and with compassion is central to excellent customer (or client) service. The client is not just a passive receiver of health information; the client-nurse relationship refers to the interaction between the nurse and the client.

The nurse greets a patient who is admitted to the hospital. Which action by the nurse displays warmth and concern? A. Use a soft and relaxed tone of voice when speaking. B. Maintain a distance of 6 to 8 feet from the patient. C. Avoid attentive behaviors when interacting with the patient. D. Engage in a verbal exchange without physical contact.

Use a soft and relaxed tone of voice when speaking. A soft, modulated tone of voice conveys warmth; warmth is also conveyed with relaxed, rhythmic speech. The spatial distance between the nurse and the patient can affect the perception of warmth; a comfortable, social distance for Americans is an arm's length to 4 feet. Touching (e.g., brief pat on the shoulder, embracing hug, or extended hand) is another way to transmit warmth. A relaxed person conveys warmth. The nurse communicates warmth when there is a genuine interest and attentiveness in the interaction with the patient.

According to Kimble and Bamford-Wade, what distinguishes the behavior of one caring and competent nurse from another nurse who is simply competent but not engaged with the patient? A. Immediacy, the availability of the nurse B. Warmth, the hallmark of compassion C. Attention, the focus of the nurse D. Communication, the instructional side of the nurse

Warmth, the hallmark of compassion Healy, a nurse patient, recounts a long wait before surgery, ponders what it was that distinguished the behavior of one caring nurse, and identifies warmth as the hallmark of compassion, also a quality of compassionate listening (Kimble and Bamford-Wade, 2013).

The home care nurse is assigned to make the first home visit to a new client who has been discharged from the hospital. After initial introductions, the nurse should take which action to convey respect? A. Ask the client to develop a list of needs to discuss at the next visit. B. Wear a name badge that clearly identifies the home care agency. C. Provide contact information for several other clients who can serve as references. D. Tell the client that information obtained will not be shared with others.

Wear a name badge that clearly identifies the home care agency. The home care nurse can convey respect at the initial visit by wearing a name badge that clearly identifies the home care agency. Another action that conveys respect during the initial visit is to determine the client's needs; the nurse should not wait until the next visit. In addition, the nurse must respect the client's right to confidentiality; client contact information should not be shared with other clients. Also, the nurse should not promise to keep secrets because the nurse must use clinical judgment about shared information that might cause potential harm to the client or someone else.

A hospital nurse is concerned about the demands of providing safe care to clients who are seriously ill. The nurse manager should suggest which intervention to effectively help the nurse balance the demanding work in the hospital setting? A. Delegate more tasks to the unlicensed nursing personnel on the unit. B. Request a transfer to another nursing care unit with patients who are stable. C. Write down stories in a journal about how caring makes a difference for patients. D. Use an assertive communication style for every patient-nurse interaction.

Write down stories in a journal about how caring makes a difference for patients. Caring is the moral ideal that guides nurses through the caregiving process. Although there is satisfaction in being technologically competent, that satisfaction is not as lasting as the satisfaction derived from meaningful moments of connection with clients, family, and colleagues.