PrepU Communicator
10. A nurse working with an experienced licensed practical/vocational nurse (LPN/LVN) delegates the task of administering oral medications to a team of clients. The nurse observes the LPN/LVN document a client's medication administration before entering the client's room. What is the most appropriate action of the nurse? a. Check all client's medication records to make sure the appropriate drugs were given. b. Stop the LPN/LVN immediately and discuss the possible consequences of this action. c. Contact the nurse manager to discuss the actions of the LPN/LVN. d. Continue to supervise the LPN/LVN as medications are being administered.
Answer 10: b. Explanation: Administration of oral medication is within the scope of practice for a LPN/LVN. However, the LPN/LVN has violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she stop the LPN/LVN immediately and discuss the possible consequences of this action. Checking all the client's medication records, contacting the nurse manager, and continuing to supervise the LPN/LVN are inappropriate actions. Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 22: Nurse Leader, Manager, and Care Coordinator, p. 520-522.
1. The nurse is providing education to a client who sometimes has difficulty remembering information. Which form of communication will be most helpful for this client? a. Verbal communication b. Written communication c. Metacommunication d. Nonverbal communication
Answer 1: b. Explanation: While all forms of communication can be used during education, it will be essential to use written communication for this client. This will allow the client to refer back to important points presented.
2. A 70-year-old female client had a cholecystectomy four days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask in order to assess the client's orientation? a. "Is your name Evelyn?" b. "Are you in a hospital?" c. "Is today the first day of the month?" d. "What day of the week is it?"
Answer 2: d. Explanation: Asking the client to identify the day of the week represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking close-ended questions, which are answered with a simple yes or no response. The remaining responses are all close-ended questions and therefore would not provide an accurate assessment of the client's orientation. Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 20: Communicator, pp. 460-461.
3. The nursing instructor is describing a professional nurse and the nurse-client relationship to the students. A sick client would most likely place the most trust in which nurse? a. A male nurse with visible tattoos, facial piercings, and a beard. b. A female nurse with mismatched scrub attire talking on her personal cell phone. c. A male nurse with a clean shaved face who is documenting at the nurses' station. d. A female nurse eating a salad in the hallway.
Answer 3: c. Explanation: It is of great importance to remember that helping relations are professional relationships. It can be helpful to identify nurse models who, through their appearance, demeanor, and behavior, communicate a clear sense of professionalism or confidence and expertise in their practice. Clients and the public are more likely to trust and value nurses who appear competent and confident and who are focused on the clients entrusted to their care. Rudeness, sloppiness, inattention to person, sexually inappropriate behavior, and other breaches of professionalism undermine nursing's professional image and the effectiveness of individual nurses. Individual expression is important, but tattoos, facial piercings, and bearded faces may hinder a trusting relationship if the client translates the expression to be unprofessional. Mismatched scrub attire and use of a personal cell phone may be perceived as unprofessional behavior. Eating in the hallway may be viewed as unprofessional; the nurse should move the food into a private break room. Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 20: Communicator, p. 460.
4. A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question? a. "All right, you have four children, is that correct?" b. "How old are your children?" c. "Were these term births?" d. "I understand you have four kids; how many times have you actually been pregnant?"
Answer 4: d. Explanation: The use of the clarifying question or comment allows the nurse to gain an understanding of a client's comment. In this scenario, the nurse is asking how many times the client has been pregnant. Gravida refers to the number of pregnancies, whereas para refers to the total number of live births. Confirming the client has four children is a form of validating what the client said. The age and/or term of the children does not clarify the original question asked by the nurse. Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 20: Communication, p. 468.
5. A graduate nurse has been working on a telemetry unit for 6 months. The nurse arrives at work in the morning and overhears a night shift nurse talking about the graduate nurse. The night shift nurse is heard saying, "That new nurse is only here to meet a doctor and get married." The best response by the new nurse would be to: a. ask to speak to the night shift nurse in private and explain how the comment made her feel. b. approach the night shift nurse and tell her that she is "out of line." c. Ignore the comment and begin her shift. d. call hospital security and ask them to take a report.
Answer 5: a. Explanation: Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a non-defensive manner. "I" statements-"I feel . . ." and "I think . . ."-play an important role in assertive statements. "You" statements are defensive and close lines of communication. The comment should not be ignored or the lateral violence will continue. It would be inappropriate to contact hospital security; the matter should be dealt with directly by the new nurse. Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 20: Communication, p. 468.
6. Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. What is an example of the proper use of social media by a nurse? a. A nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's. b. A nurse describes a patient on Twitter by giving the room number rather than the name of the patient. c. A nurse posts pictures of a patient who accomplished a goal of losing 100 pounds and later deletes the photo. d. A nurse describes a patient on Twitter by giving the patient's diagnosis rather than the patient's name.
Answer 6: a. Explanation: A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse as an individual and not the employer's. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or by accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly. Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed., Philadelphia: Wolters Kluwer Health, 2015, Chapter 20: Communicator, p. 453.
7. The nurse is visiting a hospice client in his home. He is explaining the difficulties he is having with his home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is utilizing which therapeutic nurse-client communication technique? a. Restating b. Clarification c. Reflection d. Encouraging elaboration
Answer 7: d. Explanation: Encouraging elaboration helps the client to describe more fully the concerns or problems under discussion.
8. Mrs. Miller is a 60-year-old woman status post a hip replacement. She has had multiple complications following surgery including a skin infection and a blood clot. As a result, she has been a client on the unit for 6 weeks. The nurse has just returned from vacation and this is her first day caring for Mrs. Miller. A colleagues looks at the nurse and describes Mrs. Miller as "quite difficult to deal with." The nurse knows that all of the following can contribute to difficult behaviors except: a. a quiet room. b. language barrier. c. fatigue. d. multiple family members in the room.
Answer 8: a. Explanation: Language barrier, fatigue, and having too many family members are not conducive to good communication and can lead to what is perceived as difficult behaviors in a client. Taking time to reflect on one's own triggers, as well as environmental triggers, leads to reduction of difficulties.
9. 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? a. "Don't worry about labor, I have been through it and it is not so bad." b. "There are many good medications to decrease the pain; it will not be so bad." c. "You're worried about how you will tolerate the pain associated with labor." d. "I would recommend keeping a positive attitude."
Answer 9: c. Explanation: Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives. Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 20: Communicator, p. 468.
