Active Listening: Connecting with Others/Empathy: The Foundation of Caring/Taking Aspiration Precautions

1. What is the part of the brain that most closely associated with empathy? A. Limbic system B. Neocortex C. Medulla D. Cerebellum

A. Limbic system Rationale: The limbic system controls emotion and memory, which aids our ability to empathize with others. The neocortex involves thinking, language, motor commands, and sensory perception, which contribute to empathy, but is not as closely associated with empathy as the limbic system. The medulla controls autonomic functions such as respiration, heart function, and digestion. This part of the brain is not closely associated with empathy. The cerebellum is mainly concerned with movement and equilibrium. This part of the brain is not closely associated with empathy.

5. Why would the nurse provide special instructions to nursing assistive personnel (NAP) before feeding a patient with dysphagia? A. To reduce the risk of aspirating food or fluids B. To ensure that an accurate intake measurement is reported C. To encourage the patient to eat more of the food items on the meal tray D. To ensure that the NAP knows which foods to avoid when feeding the patient

A. To reduce the risk of aspirating food or fluids Rationale: The nurse gives special instructions before the NAP feeds a patient with dysphagia because such teaching reduces the risk that the patient will aspirate food or fluids. Recording I&O accurately will have no effect in preventing aspiration, but the NAP may still need to monitor I&O if ordered. Encouraging the patient to eat will have no effect in preventing aspiration, although encouraging adequate intake is always warranted. The nurse gives special instructions before the NAP feeds a patient with dysphagia because such teaching reduces the risk that the patient will aspirate food or fluids. The nurse will ensure that the meal served to the patient is appropriate; it is not the NAP's responsibility to determine which foods to avoid.

1. Which patient is least at risk for dysphagia? A. A 22-year-old patient with a traumatic brain injury (TBI) sustained during combat. B. A 40-year-old woman undergoing stroke rehabilitation who had been smoking and taking oral contraceptives. C. A 76-year-old patient with dementia. D. A 55-year-old patient with pancreatic cancer who is receiving palliative care.

B. A 40-year-old woman undergoing stroke rehabilitation who had been smoking and taking oral contraceptives. Rationale: The risk of dysphagia is elevated in any patient with generalized muscle weakness, altered mental status, or neurological impairment of the swallowing mechanism. Pancreatic cancer is not ordinarily associated with such conditions. Chemotherapeutic agents may cause dysphagia; the 55-year-old patient, however, is receiving only palliative care. Such conditions are more common among older adults, but the 22-year-old patient with a TBI is at increased risk for dysphagia, regardless of age or mechanism of injury. The risk of dysphagia is elevated in any patient with generalized muscle weakness, altered mental status, or neurological impairment of the swallowing mechanism, such as stroke. The 40-year-old patient is at increased risk for dysphagia; however, the factors contributing to the stroke are irrelevant to this risk. The risk of dysphagia is elevated in any patient with generalized muscle weakness, altered mental status, or neurological impairment of the swallowing mechanism, such as dementia in the 76-year-old patient.

2. What would the nurse instruct nursing assistive personnel (NAP) to report while feeding any patient on aspiration precautions? A. Amount of food ingested B. Coughing C. Poor appetite D. Food preferences

B. Coughing Rationale: The nurse would instruct NAP to report the onset of coughing in any patient on aspiration precautions. NAP might or might not be asked to report the amount of food ingested. NAP might or might not be asked to report the patient's appetite. NAP might or might not be asked to report the patient's food preferences.

3. What type of question promotes more complete answers? A. Closed-ended B. Open-ended C. Reflective D. Leading

B. Open-ended Rationale: Open-ended questions prompt the most complete answers; they encourage the patient to explain something fully. Closed-ended questions elicit short answers. This type of question is useful when you need a concise, concrete result. Open-ended questions prompt the most complete answers. Reflective questions confirm or clarify something the speaker has already said. Open-ended questions prompt the most complete answers. Leading questions direct the speaker to answer in a specific way. Open-ended questions prompt the most complete answers.

2. What is empathy? A. Sharing the feelings of others B. The ability to understand the feelings of others C. The total impression you make on people through your behavior, body language, and charisma. D. Knowing how to appropriately behave in a particular situation.

B. The ability to understand the feelings of others Rationale: Empathy is the ability to understand the feelings of others. Sympathy is sharing the feelings of others. Compassion is sympathy, coupled with the desire to alleviate the suffering of others. Situational awareness is the ability to appropriately behave in a particular situation.

4. Which food item would not be given to a patient on a dysphagia diet? A. Egg salad sandwich on wheat bread B. Biscuits and gravy with scrambled eggs C. Chicken noodle soup D. Rice pudding

C. Chicken noodle soup Rationale: All of the foods listed may be eaten by a patient on a dysphagia diet except the chicken noodle soup. The liquid portion of the soup is not viscous enough to form a soft bolus in the mouth.

4. Which of these people is displaying the most attentive body language? A. Lia flips through the medical record and takes notes while the Mrs. Rush explains her medical history. B. John makes eye contact with Mr. Smith frequently as he types at his workstation and nods at one of his comments to show he is paying attention. C. Elaine puts her papers down and sits down across from Mr. Klein, hands in her lap, and makes eye contact with him while he explains his situation. D. Thomas listens to Ms. Brown while he works at making her comfortable, occasionally smiling or glancing her way.

C. Elaine puts her papers down and sits down across from Mr. Klein, hands in her lap, and makes eye contact with him while he explains his situation. Rationale: Elaine is displaying the most attentive body language. She has put away her papers and given Mr. Klein her complete attention. Lia isn't as attentive as Elaine. Lia is trying to read and listen at the same time and isn't giving Mrs. Rush her full attention. John isn't as attentive as Elaine, but he is giving the patient his attention as he takes notes. Thomas is more focused on his task of making Ms. Brown comfortable than he is on listening to her. Elaine the person displaying the most attentive body language.

2. How does active listening result in better patient care? A. Active listening causes patients to be more compliant with their treatments. B. Active listening demonstrates respect. C. Health care professionals with good listening skills are able to uncover valuable information that can be used to provide better care. D. Patients value providers who are good listeners.

C. Health care professionals with good listening skills are able to uncover valuable information that can be used to provide better care. Rationale: While active listening does demonstrate respect, and can foster a good provider-patient relationship, the benefit of active listening is in the valuable information that can be uncovered. Health care professionals with good listening skills are able to uncover valuable information that can be used to provide better care. While patients do value providers who are good listeners, the benefit of active listening is in the valuable information that can be uncovered.

4. Why is empathy important for health care professionals? A. It enables faster patient care. B. It promotes friendship. C. It promotes more successful patient care. D. It causes stress reduction in the patient and healthcare provider.

C. It promotes more successful patient care. Rationale: Empathy promotes more successful patient care, which can speed recovery and lead to better patient outcomes, but it does not make patient care faster. Empathy is important to healthcare professionals because it promotes more successful patient care though understanding, rather than friendship. In a health care environment, empathy is used to relate to coworkers as well as patients. By understanding your colleagues' feelings, you foster cooperation and teamwork. By understanding your patients' feelings, you can provide more successful patient care through increased patient compliance, better pain management, overcoming bias, and reducing the impact of health disparities. Empathy is important to healthcare professionals because it promotes more successful patient care though understanding, which can, in turn, reduce stress.

3. What is the most effective way of preventing aspiration? A. Observe the patient closely for coughing, gagging, choking, and voice alteration. B. Monitor oxygen saturation with pulse oximetry. C. Put any at-risk patient on NPO status until a dysphagia evaluation can be conducted by a speech and language pathologist (SLP). D. Watch for subtle signs that aspiration may have occurred, such as lack of speech, depressed alertness, wet quality to the voice, difficulty controlling secretions, and absence of a gag reflex.

C. Put any at-risk patient on NPO status until a dysphagia evaluation can be conducted by a speech and language pathologist (SLP). Rationale: All of the choices listed are steps that reduce the risk of aspiration. The most important precaution to prevent aspiration, however, is to put any at-risk patient on NPO status until a dysphagia evaluation can be conducted by a SLP. Monitoring the patient's oxygenation is useful in detecting silent aspiration; nevertheless, but not the most important precaution to prevent aspiration. Bedside observation, however, is insufficient. The most important precaution to prevent aspiration is to put any at-risk patient on NPO status until a dysphagia evaluation can be conducted by a SLP.

1. A communication technique where the listener gives the speaker her full attention in order to understand, respond, and remember what was said is called? A. Active listening B. Listening C. Reflective listening D. Nonverbal communication

A. Active listening Rationale: Active listening is a communication technique where the listener gives the speaker her full attention in order to understand, respond and remember what was said. Listening is the passive process of hearing someone speak. Active listening is a communication technique where the listener gives the speaker her full attention in order to understand, respond and remember what was said. Reflective listening is a communication technique where the listener repeats back what the speaker says to verify understanding. Nonverbal communication encompasses the non spoken elements of communication, including body language and facial expressions.

5. Keri is listening to Mrs. Ellison. They have found a quiet place for their conversation and Keri leans toward Mrs. Ellison and makes eye contact as they talk. By doing this, Keri is performing which part of active listening? A. Giving her full attention B. Encouraging Mrs. Ellison to elaborate on her statement C. Communicating her understanding D. Waiting for Mrs. Ellison to stop talking so she can speak

A. Giving her full attention Rationale: Keri is giving Mrs. Ellison her full attention, as shown by her eye contact and body language. Keri is giving Mrs. Ellison her full attention, as shown by her eye contact and body language. Her next step might be to encourage Mrs. Ellison to elaborate on her statement. Keri is giving Mrs. Ellison her full attention, as shown by her eye contact and body language. When Mrs. Ellison stops speaking, Keri would paraphrase Mrs. Ellison's words to communicate her understanding. Although Keri will not interrupt Mrs. Ellison while she's speaking, she is not just waiting for her turn to speak. Instead, Keri is giving Mrs. Ellison her full attention, as shown by her eye contact and body language.

5. What is the primary step in forming an empathic relationship? A. Showing interest B. Displaying authenticity C. Withholding judgement D. Active listening

A. Showing interest Rationale: The primary step in forming an empathic relationship is showing interest in a person. Authenticity, or being true to your own nature or beliefs, aids in trust; showing interest is the primary step in forming an empathic relationship. Withholding judgement aids in understanding; showing interest is the primary step in forming an empathic relationship. Active listening aids in understand; however, showing interest is the primary step in forming an empathic relationship.

3. Focusing your attention on the present, observing your environment, and accepting without judgement are aspects of which empathy-building practice? A. Active listening B. Loving-Kindness meditation C. Mindfulness meditation D. Primordial sound meditation

C. Mindfulness meditation Rationale: Mindfulness meditation is an empathy-building practice that involves focusing your attention on the present, observing your environment, and accepting reality without judgement. Active listening is the practice of paying close attention to person's verbal and nonverbal language. It is essential to effective communication. Loving-kindness meditation is an empathy-building practice that involves positivity, acceptance and kindness directed to yourself and others. Primordial sound meditation is a mantra-based technique used to still the mind.