Ch. 20 (Communication)
In which of the following situations would the SBAR technique of communication be most appropriate?
A nurse is calling a physician to report a client's new onset of chest pain.
A student nurse is attempting to improve her communication skills. Which therapeutic communication skill is appropriate?
Control the tone of the voice to avoid hidden messages.
A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication?
"I think there is a better way to handle this."
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?
"I understand you have four kids; how many times have you actually been pregnant?"
The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit post-operative following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important?
Speak directly to the client.
A nurse and an older adult patient with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point?
The nurse will be sensitive to the patient's emotional barriers.
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?
"You're worried about how you will tolerate the pain associated with labor."
A newly graduated nurse tells the charge nurse about difficulty obtaining the client's cooperation in his care. What would be the charge nurse's most appropriate response?
"The best way to obtain your client's cooperation is by first obtaining your client's trust."
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 nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's.
Paramedics arrive in the emergency department with a victim of a motor vehicle collision. The paramedic reports the driver was restrained, the car was traveling about 30 miles per hour (48 Km/hour) , and the air bags were not deployed. The paramedic continues to report the car was struck from behind and that all individuals in the car were able to self-extricate. Which statement made by the nurse is verifying the report from the paramedic?
"All of the victims got themselves out of the car?"
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:
"Can you tell me why your physician sent you here to be admitted?"
The nurse is performing an admission interview with a new client diagnosed with acute coronary syndrome. For the nurse to obtain information and allow the client free verbalization, which question would elicit the most information?
"Could you tell me more about how you are feeling right now?"
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?
"What day of the week is it?"
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?
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?
Empathy
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?
Encouraging elaboration
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. What is a characteristic of empathy?
Identifying with the client's feelings
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?
Include: Empathy, Positive Regard, and Comfortable Sense of Self. Exclude: Analysis
A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?
Open-ended question
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 neurolgoical checks every 2 hours and the nurse should report any alterations to the health care provider. In which section should this information be relayed?
Recommendation
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?
Stop the LPN/LVN immediately and discuss the possible consequences of this action.
A nurse has been caring for a client who suffered a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how he feels. Which scenario warrants further investigation?
The client stares at the floor and states, "I feel fine."
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?
Working phase
Each of the following facilitates a therapeutic nurse-client relationship except:
closed-ended questions.
The nurse is caring for a client. When does the nurse determine that nursing care will be most effective related to nurse-client communication?
common understanding.
A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse:
sits at the client's bedside and faces the client.
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:
swaddling the child and gently stroking its head.
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?
"Have you ever thought of laser surgery?"
When the preoperative client tells the nurse that he cannot sleep because he keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is:
"The thought of having surgery is keeping you awake."
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process?
-The nurse shows patience with the client and gives the client time to respond. -The nurse maintains eye contact with the client. -The nurse keeps communication simple and concrete.
A nurse is planning care for an adult client with severe hearing impairment that uses sign language and lip reading for communication that has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care?
Arrange for a sign language interpreter when discussing treatment.
The nursing instructor is discussing communication with a student. The student identifies that a contract is made with the client during which phase of the nurse-client relationship?
Orientation phase
When caring for a psychiatric client, a formal contract is made with the client during which phase of the nurse-client relationship?
Orientation phase
Which best describes an element of the nurse-client relationship?
The nurse self-discloses only what is necessary for the client's benefit.
A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?
The working phase
An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse she is afraid of waking up during surgery. The best response by the nurse is to:
ask the client why she thinks she will wake up during surgery.
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:
ask to speak to the night shift nurse in private and explain how the comment made her feel.
A nurse is on his lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. The nurse recognizes one of the physicians as being in charge of his clients. The nurse witnesses the physician point at the nurse and state, "That guy needs to get fired." The best response by the nurse would be to:
ask to speak to the physician in private and address any disrespectful remarks or behaviors.
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 who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique?
giving false reassurance
The mother of a toddler is deciding if she wants to allow her child to receive the recommended immunizations. The clinic nurse responds, "If you don't immunize your child you are jeopardizing the health of other children." What type of approach does this response indicate?
guilt inducement or approval/disapproval
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 nurse communicating with a client states, "I will be changing your dressing, but we have plenty of time to talk first." She is already wearing sterile gloves and a mask and is busy working with her back to the client. The nurse is conveying a (an)
incongruent relationship.
A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:
involve the child's stuffed animal in the educational session.
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug abuser. To foster effective communication, the nurse should:
remain honest, open, and frank.
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out?
reviewing health changes
A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should:
sit at the bedside and allow the client to explain the statement.
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 of the following statements conveys empathy on part of the nurse?
"I know this is hard for you. Is there any way I can 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?
"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."
A nurse gives a speech on nutrition to a group of pregnant women. What is the speech itself known as?
Message
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
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.
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:
allow the client to set the pace.
A client arrives at the emergency department after experiencing several black, tarry stools. The nurse will develop a cause and effect by:
asking the client if he or she has recently taken ferrous sulfate (iron) or bismuth subsalicylate.
The term meta-communication is best defined as:
interpersonal bridge between verbal and nonverbal communication.
A nurse is caring for a client in a semi-private room. The nurse is preparing to discuss the medical treatment plan with the client. To best ensure privacy the nurse should:
pull the curtain dividing the two beds, maintain eye contact, and speak in a low, audible voice.
A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because she has not performed wound care on a complex wound in the past. Using effective intrapersonal communication, this nurse should:
tell herself to "remain calm" and remember that she was trained to perform this skill.
The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions?
-"Are you ready to get out of bed?" -"Does it hurt when I touch you here?" -"Is there any chance you might be pregnant?" -"Do you smoke cigarettes?"
Which nursing actions would most likely help improve communications with patients and achieve a more effective helping relationship?
-The nurse makes statements that are as simple as possible, gearing conversation to the patient's level. -The nurse controls the tone of his or her voice so that it conveys exactly what is meant. -The nurse takes advantage of any available opportunities to communicate information to patients in routine care-giving situations.