PrepU Chapter 8: Communication

The nurse is caring for a client who had a stroke with residual affective aphasia. What is an effective method(s) for the nurse to communicate with the client? Select all that apply.

- provide the client with a tablet or whiteboard to attempt communication - patiently await the client's responses after asking question - have the client point to common phrases or spell with alphabet letters on a laminated form

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

"I think all went well with your physical, don't you? "Do you have any questions about all that was discussed during the exam?" ***"We reviewed your plans for your new diet and medications. Do you have any other questions?" "Will we see you in 6 months to see how your diet has progressed?"

A nurse is discharging a client and thus terminating the nurse-client relationship. Which action should the nurse perform in this phase?

Examine goals of the relationship to determine whether they were achieved

A nurse touches the client's hand while discussing the client's diagnosis. This action is:

a dynamic process. a translation. **a communication channel. an auditory channel.

A client was recently diagnosed with metastatic lung cancer. The nurse finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy?

"I am sorry to hear you have cancer. I would be upset too, is there anything I can do?" "I see you are upset. Would you like to talk?" ***"I see you have been crying. Do you want me to call someone for you?" "Don't worry, I have seen lots of people with cancer do fine."

When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is:

"It sounds as if your surgery is a pretty scary procedure." "You have a great surgeon. You have nothing to worry about." "You shouldn't be nervous. We perform this procedure every day." ***"The thought of having surgery is keeping you awake."

A nurse has developed strong rapport with the spouse of a client who has been receiving rehabilitation following a debilitating stroke. The spouse has just been informed that the client is unlikely to return home and requires care that can only be provided in a facility with constant nursing care. The client's spouse tells the nurse, "I can't believe it's come to this." How should the nurse best respond?

"This must be very difficult for you to hear. How do you feel right now?"

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

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

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

**"You seem unsure. Tell me your concerns about your surgery." - "I understand your confused, what do you think you should do?" - "I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?" - "You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure."

A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:

- staring into the neonate's eyes and smiling. softly humming a song near the neonate. ***swaddling the child and gently stroking its head. - offering the neonate infant formula.

Which nurse would most likely be the best communicator?

An advanced practice nurse ***A nurse who easily develops a rapport with clients A nurse who is bilingual A nurse who is proficient in sign language

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

Assertive

A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response?

Be silent and allow the client to continue speaking when ready.

A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment?

Direct the client in the other bed to walk in the hallway. Ask all visitors to leave the room. ***Pull the curtain dividing the two beds. Bring the client into the hallway to discuss the treatment plan.

Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached?

Empathy

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation?

Indifference Pity Sympathy *Empathy

When caring for a psychiatric client, a nurse would make a formal contract with the client during which phase of the nurse-client relationship?

Intimate phase *Orientation phase Working phase Termination phase

An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is nervous about the surgery. The best response by the nurse is to:

Look directly at the client and state, "You are nervous about the surgery." Ask the surgeon to come to the bedside to reassure the client. State "Everyone is nervous before surgery." ****Ask the client "Can you tell me more about what is worrying you?"

Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?

Orientation phase **Working phase Termination phase Evaluation phase

A nurse is attempting to communicate with a client who speaks a different language and is not fluent in the nurse's language. Which nursing action would best facilitate the communication process?

Speak slowly and distinctly, but not loudly.

A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.

The nurse maintains eye contact with the client. The nurse keeps communication simple and concrete. The nurse shows patience with the client and gives the client time to respond

A nurse who is caring for newborn infants delivers care by utilizing the sense that is most highly developed at birth. Which example of nursing care achieves this goal?

The nurse speaks to the infant in a loud voice to get attention. The nurse plays "peek-a-boo" with the infant. The nurse wears colorful clothing to stimulate the infant. ***The nurse gently strokes the baby's cheek to facilitate breastfeeding.

The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes?

contacting the interprofessional care team to discuss alternative treatment options

A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:

eliminate as many distractions as possible.

A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: -ask the client's partner to leave the room to allow the client to focus. -ask all visitors to leave the room. -ask the client if she is able to read. -eliminate as many distractions as possible.

eliminate as many distractions as possible. Explanation: Factors that distort the quality of a message can interfere with communication at any point in the process. These distractors might be from the television, or from pain or discomfort experienced by the client. Visitors may remain in the room as long as the mother agrees and they do not interfere with the education session. It may also be beneficial for others to learn the care in the event that they too will be caregivers for the infant. For this reason, it is best for the client's partner to remain in the room.

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

"Do you feel like you are not a woman?" "Do you want more children?" ***"Feel like a woman . . ." Remaining silent

A client is reluctant to undergo surgery and is discussing it with the nurse. Which response by the nurse would reflect an authoritarian approach?

"Surgery is your only option. You need this operation."

The nurse cares for a client who is sharing a personal health story. Which behavior(s) demonstrates active listening? Select all that apply.

-The nurse makes eye contact while the client is sharing a personal story. -The nurse observes the nonverbal behavior of the client as the client speaks. -The nurse paraphrases what the client has stated before generating a response.

The nurse makes a contract with the client during which phase of the nurse-client relationship?

Orientation phase

A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to:

have group members confront the dominant member to promote the needed team work.

A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take?

- Allow the client's child to interpret. - Involve a friend who speaks both the - dominant and the client's languages. **Contact a professional interpreter. - Ask a fellow nurse who knows some words in the client's language to help.

A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client?

"I will be by your side throughout the procedure; the procedure will be painless if you don't move." ***"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." "The procedure may take only 2 minutes, so you might get through it by mentally counting up to 120." "You may feel very uncomfortable when the needle goes in, but you should breathe rhythmically."

A nurse has developed strong rapport with the spouse of a client who has been receiving rehabilitation following a debilitating stroke. The spouse has just been informed that the client is unlikely to return home and requires care that can only be provided in a facility with constant nursing care. The client's spouse tells the nurse, "I can't believe it's come to this." How should the nurse best respond?

****"This must be very difficult for you to hear. How do you feel right now?" "Why do you think that the care team has made this recommendation?" "Do you understand that everyone here has your spouse's best interest at heart?" "What would help you accept that this is best for both of you?"

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

**closed-ended questions. rephrasing. active listening. reflection.

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

- "I am so sorry you are going through this. Can we talk?" **"I know this is hard for you. Is there any way I can help?" - "Sitting in the dark is not going to cure your cancer. Let's open the curtains." - "Can you please tell me why you are crying?"

The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?

Restating Clarification Reflection **Encouraging elaboration

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

Sympathy Curiosity ***Empathy Humility

Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?

empathy positive regard **analysis comfortable sense of self

A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication?

"Close your eyes and take a deep breath. I know you were frightened, but the baby is healthy and everything is going to be okay." "This is great news. You don't have anything to worry about and the baby is doing well." "I can help you, please talk to me so that I know how I can help you." ****"Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you."

A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse?

"Don't worry about labor, I have been through it and it is not so bad." "There are many good medications to decrease the pain; it will not be so bad." ****"You're worried about how you will tolerate the pain associated with labor." "I would recommend keeping a positive attitude."

A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?

**Orientation phase Working phase Termination phase Evaluation phase

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

**aggressive. assertive. passive. nurturing.

What nursing care behavior by the nurse engenders a client's trust in the nurse?

- A nurse tells the client, "Do not worry about the test, I have never cared for anyone that had problems with it." -A nurse answers the client's questions about an upcoming test while completing documentation in the EHR. ****A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. - A nurse tells the client, "My shift will be over in 45 minutes, I will let the oncoming nurse know you have questions about tomorrow's test."

A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response?

**Be silent and allow the client to continue speaking when ready. - Smile and say, "Don't worry, I am sure the physician is doing a good job." - Nod and say, "I agree. If I were you, I would get a new doctor." - Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."

The nurse is providing care to an older adult client who has visual and hearing deficits. What action by the nurse is appropriate to help with communication?

Remove the COVID protection face mask while speaking with the client. Speak in a loud voice over the volume of the television set. ***Identify oneself by name and title with each entry into the client's room. Obtain the client's attention by calling out the client's first name.

A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point?

- Explaining in detail all of the pain management options available **Being sensitive to the client's emotional barriers - Sharing the nurse's own family and personal history of back pain - Reassuring the client that back surgery will likely alleviate the pain completely

The nurse is beginning an assessment on a nonverbal client. The nurse must first: -speak loudly when interacting with the client. -use various forms of communication when interacting with the client. -establish eye contact prior to assessing, touching, and interacting with the client. -verbalize all steps of the nursing assessment when interacting with the client.

-establish eye contact prior to assessing, touching, and interacting with the client. Explanation: -Establishing eye contact is the first action with all clients, especially nonverbal clients, prior to touching the client. Nonverbal clients are not necessarily hard of hearing. It is always good to speak to a client in a pleasant tone of voice and not "loudly," as well as to use multiple forms of communication and to verbalize all steps of the nursing assessment when interacting with clients. These actions, however, are not the first actions.

The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client?

***Approach the client with empathy and understanding and allow the client to share feelings without being judged. - Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive. - Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding. - Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation.

A nurse and client are in the working phase of the helping relationship. What outcome statement developed by the nurse and client correlates with this phase?

***The client will express feelings and concerns to the nurse. - The client and nurse will establish goals of the relationship. - The nurse and client will determine where and when they will meet. - The client will identify the goals that have been accomplished during the relationship.

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

-Empathy Explanation: An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. Sympathy is the expression of sorrow for someone's situation, involving compassion and kindness. Sympathy shifts the emphasis from the client to the nurse, as the nurse shares feelings and personal concerns and projects them onto the client. Curiosity is a strong desire to know or learn something. Empathy is perceptive awareness of what a client is experiencing. Humility is a modest or low view of one's own importance.

A nurse is on lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. One of the physicians, who is in charge of the nurse's clients, points at the nurse and states, "That guy needs to get fired." The best response by the nurse would be to: -call the nursing supervisor to address the situation at hand. -ask to speak to the physician in private and address the disrespectful remark. -return to the nurse's home unit and ask to meet with the charge nurse. -write a written account of what transpired and contact an attorney.

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

A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:

Ask questions as quickly as possible. Use only open-ended questions. Tell the client to rest and allow a family member to answer. **allow the client to set the pace.

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

aggressive Explanation: Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication.

The nurse is reporting to an oncoming nurse about the care of a client using the SBAR format. The nurse informs the oncoming nurse that the client should continue to have neurological checks every 2 hours and the nurse should report any alterations to the health care provider. In which section should this information be relayed? -Situation -Background -Assessment -Recommendation

Recommendation Explanation: This information is the recommendation of the nurse regarding the client's condition. It is not discussing background information related to the client, the situation of the client, or any assessment information related to the client.

A nurse is caring for a client admitted to the hospital for dehydration. Which physical findings should the nurse acknowledge as nonverbal communication concerning this diagnosis? -easy wrinkling of the skin and sunken eyes. -slow heart rate and prolonged capillary refill. -pallor and diaphoresis. -cold intolerance and brittle nails.

easy wrinkling of the skin and sunken eyes. Explanation: Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone. On the other hand, a person in good health tends to radiate this healthy status through general appearance. Although prolonged capillary refill is consistent with dehydration, slow heart rate is not. Pallor may be associated with dehydration but diaphoresis is not associated with this condition. Cold intolerance and brittle nails are consistent physiologic changes seen in clients with hypothyroidism.

A client has just been given a diagnosis of cirrhosis of the liver. Which statements by the nurse should be avoided because they could impede communication? Select all that apply. -"Cheer up. Tomorrow is another day." -"Your doctor knows best." -"That's a lot of information to take in. Would you like to talk about it?" -"Don't worry. You will be just fine in another day or two." -"Everything will be all right."

"Your doctor knows best." "Everything will be all right." "Cheer up. Tomorrow is another day." "Don't worry. You will be just fine in another day or two." Explanation: A clichés© is a stereotyped, trite, or pat answer. Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Clients tend to interpret them as a lack of real interest in what they have said. For example, even though the common question "How are you?" could start a conversation, it can cause a problem if the client hearing this suspects that the nurse is not sincerely interested in how he feels. Statements such as: "Everything will be all right," "Don't worry," and "Cheer up" impede communication and foster false hope. Stating your doctor knows best can lead to powerlessness in the client. On the other hand, acknowledging that the client has just received a lot of information and that it is understandable if the client is struggling to process it all is empathetic, and offering to talk about it opens up a line of communication rather than closing it.

The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client?

- "This is so sad and I feel so bad that you are in this situation." **"It sounds as though you are most concerned about how your children will feel." - "I am so sorry that I am crying with you when you need my support the most." - "This just is not fair at all and I do not understand why this is happening to you."

A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation?

- The client is sitting in a chair and states, "I feel a lot better than I did yesterday. **The client stares at the floor and states, "I feel fine." - The client smiles at the nurse and states, "I cannot wait to go home." - The client looks at the nurse and states, "I am still not feeling my best."

The client is an 18-month-old in the pediatric intensive care unit. The client is scheduled to have a subgaleal shunt placed tomorrow, and the client's mother is quite nervous about the procedure. The nurse tells the client's mother, "The surgeon has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication?

Rescue feelings **False reassurance Giving advice Being moralistic

A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client?

***Arrange for a sign language interpreter when discussing treatment. - Talk with the client's children to determine needs. - Consult the oncology nurse specialist. - Use a text-telephone device (TTD) for daily communication.

A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response? -"You should follow your physician's recommendation and have the surgery." -"When you see the physician this morning, request more information about the surgery." -"It is a minimally invasive surgery with rapid recovery time, so you will do fine." -"Share with me the advantages and disadvantages of your options as you see them."

"Share with me the advantages and disadvantages of your options as you see them." Explanation: When it comes to treatment decisions, the nurse should avoid giving advice, thus reserving the right of each person to make one's own choices on matters affecting health and illness care. The nurse should share information on potential alternatives, promote the client's freedom to choose, and support the client's ultimate decision. Giving advice, avoidance, and providing false reassurance are all nontherapeutic forms of communication.