Chapter 2 Interview Process

A nurse is conducting a review of systems with a client and is asking about his ears. The nurse asks, "Do you have any problems with your ears or your hearing?" The client stares blankly at the nurse a moment and then says, "I'm sorry—could you repeat that?" The nurse repeats the question, to which the client replies, "No." The nurse then asks, "Do you ever experience any trouble hearing or any ringing, buzzing, or earaches?" The client responds, "No." What should the nurse record under "Ears" in the review of systems section of the client's health history? a) "Denies any trouble hearing or any ringing, buzzing, or earaches." b) "No problems." c) Nothing—it should be left blank d) "Client denies any problems but had trouble hearing me when I asked him a question."

"Denies any trouble hearing or any ringing, buzzing, or earaches." Explanation: During the review of body systems, document the client's descriptions of her health status for each body system and note the client's denial of signs, symptoms, diseases, or problems that the nurse asks about but are not experienced by the client. If the lone entry "no problems" is entered on the health history form, other health care professionals reviewing the history cannot ascertain what specific questions had been asked, if any. Care must be taken in this section to include only the client's subjective information and not the examiner's observations.

A nurse is interviewing a man complaining of a pain in his shoulder. The nurse asks him where exactly the pain is, and he points to a spot on the lateral, posterior upper arm. The nurse has seen similar cases in other clients and recognizes that is likely from prolonged work at a computer, particularly using a mouse. Which of the following is the most effective use of inferring that the nurse might implement in this situation? a) "Do you perform any sustained or continually repetitive motions with that arm?" b) "You work at a computer a lot, don't you?" c) "I recommend that you change your posture while working at the computer." d) "When did the pain start?"

"Do you perform any sustained or continually repetitive motions with that arm?" Explanation: Inferring information from what the client tells you and what you observe in the client's behavior may elicit more data or verify existing data. Be careful not to lead the client to answers that are not true. The question, "Do you perform any sustained or continually repetitive motions with that arm?" is open enough to not lead the client to an expected answer but narrow enough for the nurse to help elicit more information from the client about probable causes of his pain. Recommending that the client change his posture while working at the computer is premature, as the nurse has not confirmed that the computer work is the culprit.

A client presents to the health care clinic with reports of sleeplessness and loss of appetite. The client tells the nurse that his wife is seriously ill in the hospital and he has not been able to visit her much because of transportation problems. Which open-ended question should the nurse ask the client to obtain more information about his presenting symptoms? a) "Are you taking any new medications?" b) "Do you think your wife is getting better?" c) "Have you lost any weight this week?" d) "When did the sleeplessness first start?"

"Do you think your wife is getting better?" Explanation: Open-ended questions are used to elicit information about a client's feelings or perceptions about a particular situation. In this case, the husband may be grieving over the wife's illness & the nurse needs to gather information about he feels or perceives her illness in relation to his ability to care for himself. The other questions will provide information about the client's physical symptoms.

The nurse is performing a follow-up assessment and interview of a 72-year-old woman with a history of congestive heart failure. The nurse asks the client, "Have you been experiencing any activity intolerance since I last saw you?" What would be a more appropriate way for the nurse to elicit this information? a) "Has your heart failure been causing you any dyspnea lately?" b) "Do you ever find yourself SOB when you're carrying out your daily routines?" c) "Has this been having an effect on your ability to carry out your routines and get around your home?" d) "Has your congestive heart failure been affecting your activities of daily living recently?"

"Has this been having an effect on your ability to carry out your routines and get around your home?" Explanation: When initiating an interview, it is important to use language that is understandable and appropriate to the client. "Dyspnea," "SOB," and "activities of daily living" are potentially unclear to a client and reflect clinical language rather than clear communication

While interviewing an adult client about the client's stress levels and coping responses, an appropriate question by the nurse is a) "Is stress a problem in your life?" b) "How often do you feel stressed?" c) "Do you feel stress at work?" d) "How do you manage your stress?"

"How do you manage your stress?" Explanation: To investigate the amount of stress clients perceive they are under and how they cope with it, ask questions that address what events cause stress for the client and how they usually respond. In addition, find out what the client does to relieve stress and whether these behaviors or activities can be construed as adaptive or maladaptive.

Which of the following questions is most useful in the assessment of a client's diabetes management? a) "You check your sugars before each meal, don't you?" b) "Are you still using your glucometer 4 times a day?" c) "Are you staying vigilant with your blood sugar monitoring?" d) "What is your routine for checking your blood sugar these days?"

"What is your routine for checking your blood sugar these days?" Explanation: Answer D is an open-ended question, while the other answers are leading questions that elicit yes-no responses

A nurse is using the COLDSPA mnemonic to collect data on a client's chief complaint, which is a spell of numbness and tingling on her left side. Which of the following questions would be best for eliciting information related to the component "associated factors"? a) "How bad was the tingling and numbness?" b) "What other symptoms occurred during the spell? c) "Where did the numbness and tingling occur?" d) "How long did the spell last?"

"What other symptoms occurred during the spell? Explanation: The mnemonic "COLDSPA" is used by nurses to help analyze a client's chief complaint. It stands for character, onset, location, duration, severity, pattern, and associated factors. Examples of questions related to associated factors include the following: "What other symptoms occur with it? How does it affect you? What do you think caused it to start? Do you have any other problems that seem related to it? How does it affect your life and daily activities?" The question, "How bad was the tingling and numbness?" relates to severity. The question, "How long did the spell last?" relates to duration. The question, "Where did the numbness and tingling occur?" relates to location.

"How many steps can you climb before you get short of breath?" is an example of what kind of question? a) A question that offers multiple choices for answers b) A question that is qualitative in focus c) A question that elicits a graded response d) A question that demands an imprecise response

A question that elicits a graded response Explanation: The nurse should ask questions that require a graded response rather than a single answer. "How many steps can you climb before you get short of breath?" is better than "Do you get short of breath climbing stairs?" This question is neither qualitative nor imprecise.

A nurse is interviewing an adult client who had a miscarriage 3 weeks ago. The woman is crying and is having difficulty talking. The nurse moves closer and places a hand on the woman's hand. What type of communication is this? a) Restatement b) Reflection c) Encouraging elaboration (facilitation) d) Active listening

Active listening Explanation: Active listening is the ability to focus on the client and their perspectives. It requires the nurse to constantly decode messages including thoughts, words, opinions, and emotions. For example, if a client is sad, it is appropriate for a nurse to place a hand over the client's and to show a facial expression of compassion. The purpose of restatement is to have the client elaborate on what was originally stated by the client. Reflection uses summarizing by the nurse to find the true meaning of a client's words. Encouraging elaboration encourages the client to explain or go into more detail in the client's responses

During one of your clinical placements you encounter a patient who becomes silent during the nursing interview. What would be appropriate for you to do? (Mark all that apply.) a) Appear attentive b) Give brief encouragement to the patient c) Change the subject you are asking about d) Watch the patient closely for nonverbal cues e) Ask your question again

Appear attentive • Give brief encouragement to the patient • Watch the patient closely for nonverbal cues Explanation: The period of silence usually feels much longer to the nurse than it does to the patient. The nurse should appear attentive and give brief encouragement to continue when appropriate. During periods of silence, watch the patient closely for nonverbal cues, such as difficulty controlling emotions. Repetition may make the patient more uncomfortable and further hinder communication. The nurse should implement the other listed techniques before changing the subject

A nurse collects data about a client's family health history. Which family members' health problems should the nurse include when documenting this information in the database? a) As many genetic relatives as the client can recall b) Only the members with health problems that relate to the client's gender c) Those with illnesses that resulted in death or disablement d) Those with diseases that are known to have a genetic link

As many genetic relatives as the client can recall Explanation: Both maternal and paternal genetic relatives are included in the family health history. Problems can arise in families that are not genetically based but are manifest by virtue of exposure to lifestyle practices. Parents, grandparents, aunts, uncles, and children are all included in this history. If the relative is deceased, the cause of death and age of death of the relative is recorded

A nurse collects data about a client's family health history. Which family members' health problems should the nurse include when documenting this information in the database? a) As many genetic relatives as the client can recall b) Only the members with health problems that relate to the client's gender c) Those with diseases that are known to have a genetic link d) Those with illnesses that resulted in death or disablement

As many genetic relatives as the client can recall Explanation: Both maternal and paternal genetic relatives are included in the family health history. Problems can arise in families that are not genetically based but are manifest by virtue of exposure to lifestyle practices. Parents, grandparents, aunts, uncles, and children are all included in this history. If the relative is deceased, the cause of death and age of death of the relative is recorded.

The nurse is caring for a client exhibiting slurred speech after suffering from a cerebrovascular accident. The nurse is unable to completely understand the client. What is the nurse's best action? a) Turn the television on for distraction. b) Change the subject to put the client at ease. c) Refer all questions to the client's family member in room. d) Ask the client to repeat the statement or question.

Ask the client to repeat the statement or question. Explanation: The nurse should ask clients to repeat questions or statments if the nurse is unable to understand what the client said. The nurse can also paraphrase client responses to verify understanding.

What techniques encourage patient disclosures while minimizing the risk for distorting the patient's ideas or missing significant details? (Mark all that apply.) a) Using reflection b) Encouraging with repetition c) Asking only open-ended questions d) Offering multiple choices for answers e) Asking a series of questions, one at a time

Asking a series of questions, one at a time • Using reflection • Offering multiple choices for answers Explanation: Learning the following techniques encourages patient disclosures while minimizing the risk for distorting the patient's ideas or missing significant details. • Moving from open-ended to focused questions • Using questioning that elicits a graded response • Asking a series of questions, one at a time • Offering multiple choices for answers • Clarifying what the patient means • Encouraging with continuers • Using reflection

The nurse is preparing to conduct an interview with a hospitalized patient. What nursing intervention can best ensure a confidential and comfortable environment for the patient? a) Explaining why it is important to take notes during the interview. b) Conducting the interview after the client's visitors have left. c) Implementing therapeutic communication techniques during the interview. d) Asking permission to draw the client's privacy curtain.

Asking permission to draw the client's privacy curtain. Explanation: In order to support effective communication, the client must feel that the environment is comfortable and the conversation will be confidential. Drawing the privacy curtain is an effective way to project privacy and thus improve the comfort on the environment where the interview will take place. While it is preferable to conduct the interview at a time when visitors are not present, it may not be realistic to wait until the client is alone. Explaining the advantage of notes and using therapeutic communication techniques are associated with effecting good communication but are not directly associated with environment control

When conducting the health assessment, the nurse interacts with the client in a caring manner. How would the nurse demonstrate caring to the client? Select all that apply. a) Dressing in a relaxed and casual manner b) Being sympathetic c) Valuing the client unconditionally d) Showing respect to the client e) Being nonjudgmental

Being nonjudgmental • Showing respect to the client • Valuing the client unconditionally Explanation: Caring encompasses the nurse's empathy for and connection with the client. The nurse shows warmth, caring, interest, and respect and values the client unconditionally and nonjudgmentally. Being sympathetic and dressing in a relaxed and casual manner are nontherapeutic and would not show caring.

Mrs. T. comes for her regular visit to the clinic. Her regular provider is on vacation, but the client did not want to wait. The nurse has heard about this client many times from colleagues and is aware that she is very talkative. Which of the following is a helpful technique to improve the quality of the interview for both provider and client? a) Allow the client to speak uninterrupted for the duration of the appointment. b) Briefly summarize what the client says in the first 5 minutes and then try to have her focus on one aspect of what she discussed. c) Allow impatience to show so that the client picks up on nonverbal cues that the appointment needs to end. d) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview.

Briefly summarize what the client says in the first 5 minutes and then try to have her focus on one aspect of what she discussed. Correct Explanation: The nurse can also say, "I want to make sure I take good care of this problem because it is very important. We may need to talk about the others at the next appointment. Is that OK with you?" This is a helpful technique that can help the nurse to change the subject, but at the same time, validate the client's concerns; this can provide more structure to the interview.

During an interview, the nurse remains silent and nods the head periodically while the patient is talking. The therapeutic communication technique the nurse is using would be: a) Continuers b) Reflection c) Summarization d) Validation

Continuers Explanation: The nurse who uses gestures, posture, silence, and head nodding is using cues for the patient to continue or continuers. Reflection is repeating the patient's last words to encourage the patient to express both factual details and feelings. Validation is a way to make a patient feel affirmed to acknowledge the legitimacy of an emotional experience.

One technique of therapeutic communication is silence. What does silence allow the patient to do? a) Change topics if he or she wants b) Learn to trust the nurse c) Decide how much information to disclose d) Communicate concerns nonverbally

Decide how much information to disclose Correct Explanation: Silence may give patients a chance to decide how much information to disclose.

The nurse is focusing an interview on a patient's respiratory status. Which question should the nurse ask first to begin this interview? a) Do you currently have a cough? b) Describe how you breath for me? c) Do you experience any pain when you breathe? d) Do you have any difficulty producing sputum?

Describe how you breath for me? Explanation: During an interview, questions should proceed from general to specific. The question that is the most general is "describe your breathing." This provides the patient with an opportunity to discuss the current breathing pattern with the nurse. The other questions are specific and will elicit a yes-no response

A nursing instructor is discussing therapeutic versus nontherapeutic responses with nursing students. Which of the following would the nurse identify as nontherapeutic? a) Distraction b) Clarification c) Summarizing d) Focusing

Distraction Explanation: Distractions in the environment contribute to nontherapeutic communication. Clarification, summarizing, and focusing are all important aspects of therapeutic communication.

A nurse is examining a child who is suspected of having bronchitis and is preparing to auscultate his chest with a stethoscope. Which of the following actions would demonstrate the correct technique for this procedure? a) Ensuring that contact with the skin is maintained b) Application of firm pressure when using the bell c) Using the diaphragm to listen to low-pitched sounds d) Using the bell to detect high-pitched sounds

Ensuring that contact with the skin is maintained Explanation: While using a stethoscope to listen to air movement through the respiratory tract, the nurse should avoid listening through clothing, as it may obscure or alter the sound. However, too much pressure should not be applied when using the bell, as it would cause it to work like a diaphragm. The diaphragm is used to listen to high-pitched sounds, whereas the bell is used to listen to low-pitched sounds.

A nurse is collecting subjective data from a client as part of the assessment process. Which behavior is most appropriate for the nurse to display in this situation? a) Remaining standing during the interview b) Explaining the reason for taking down notes c) Maintaining eye contact with the client at all times d) Reading questions from the history form

Explaining the reason for taking down notes The nurse should explain the reason for taking notes during the interview and ensure that it will remain confidential; this will help the client to provide all the required information during the interview. Some clients may be very uncomfortable with too much eye contact, while others may believe that the nurse is hiding something from them if eye contact is avoided. Therefore, the nurse should maintain only a moderate amount of eye contact and not maintain eye contact with the client at all times. The nurse should not remain standing while taking down notes, as it could indicate being in a hurry to complete the interview; it could also indicate that the nurse is expressing superiority over the client.

How would the nursing instructor explain the goal of guided questioning to his or her students? a) Facilitating the patient's fullest communication b) Providing the most plausible answer to the patient c) Developing a basis for accurate health promotion activities d) Creating an opportunity for the early generation of a plan

Facilitating the patient's fullest communication Explanation: The main goal of guided questioning is to facilitate the patient's fullest communication. The early generation of a plan is not a paramount goal and it is incorrect to suggest particular answers to the patient

When interviewing, the nurse should logically move from specific to open-ended questions. a) False b) True

False

A graduate nurse working on a medical-surgical unit is admitting a client who does not speak English. No interpreters are available. The client's spouse is present and speaks English. What should the nurse remember about the use of interpreters when communicating with clients? a) Friends and family who are unfamiliar with medical terminology may misinterpret information b) Using children in the family, other relatives, or close friends as interpreters does not violate privacy laws c) Interpreters do not understand cultural health beliefs and practices, so they are unable to help bridge the gap d) Hospital interpreters may not always be the best choice because they are unfamiliar with the client

Friends and family who are unfamiliar with medical terminology may misinterpret information Explanation: Friends and family who are unfamiliar with medical terminology may misinterpret information. When possible, a trained medical interpreter is preferred. Using children or other relatives violates the client's privacy. It does not matter if the hospital interpreter knows the client; the interpreter can still accurately interpret for the health care provider.

Learning about the effects of the illness does what for the nurse and the patient? a) Gives them the basis to establish a trusting relationship b) Gives them each a better understanding of the other c) Gives them the ability to communicate better d) Gives them the opportunity to create a complete and congruent picture of the problem

Gives them the opportunity to create a complete and congruent picture of the problem Correct Explanation: Learning about the effects of the illness gives the nurse and the patient the opportunity to create a complete and congruent picture of the problem.

A nurse will be performing a complete physical examination of a man who has emphysema with a chronic productive cough, including an assessment of his oral cavity. Which pieces of personal protective equipment should the nurse wear? a) Mask, protective eye goggles b) Mask, protective eye goggles, gown c) Gloves, mask, protective eye goggles, gown d) Gloves, gown

Gloves, mask, protective eye goggles, gown Because this client has emphysema with a chronic productive cough, it is likely that the nurse will not only come into direct contact with the client's sputum or mucus (a body fluid) during examination of his oral cavity, which requires the use of gloves, but also that sputum will be sprayed on the nurse's face and body, which requires the use of a mask, protective eye goggles, and a gown.

Which action should a nurse implement when assessing a non-native client to facilitate collection of subjective data? a) Maintain a professional distance during assessment b) Ask one of the client's significant others to interpret c) Avoid any eye contact with the client d) Speak to the client using local slang

Maintain a professional distance during assessment Explanation: When assessing a non-native client, the nurse should maintain a professional distance during assessment; the size of personal space affects one's comfortable interpersonal distance. The nurse should not speak to the client using local slang because, if the client finds it difficult to learn the proper language, slang would be much more difficult to understand. The nurse need not avoid any eye contact with the client, but should maintain eye contact with the client as required, without giving the client reason to think that the nurse is being rude. Asking one of the client's significant others to interpret during the interview may actually impair the assessment process.

A nurse is interviewing an older adult client who has come to the clinic for the first time. The nurse prioritizes questions for which of the following reasons? a) Older adults have longer health histories b) Older adults take more medications c) Older adults know which subjects are most important d) Older adults tire more easily

Older adults tire more easily Explanation: It may be necessary to prioritize questions, because older adults become tired more easily than younger people. The prioritization of questions asked of an older adult is not indicated by older adults knowing which subjects are more important, having longer health histories, or taking more medications

A nurse is using the COLDSPA mnemonic to collect data on a client's chief complaint, which is pain in the heel of his foot. The nurse asks the client, "When did this pain start?" Which component of symptom analysis does this question represent? a) Pattern b) Duration c) Onset d) Character

Onset Explanation: The onset of a symptom is when it began. The character of a symptom is a description of the quality of the symptom. Duration is how long the symptom lasts when it occurs. Pattern refers to factors that make the symptom better or worse.

During a physical examination of a client, the nurse assesses the size of the liver. Which of the following techniques should the nurse use for this assessment? a) Percussion b) Auscultation c) Inspection d) Palpation

Palpation Explanation: Palpation is the use of tactile pressure from the fingers to assess contours and sizes of organs. Inspection is close observation of the details of a client's appearance, behavior, and movement. Percussion is the use of a finger of one hand to strike a finger of another hand for the purpose of eliciting a tone or sound wave.

A clinic nurse is caring for a newborn and the newborn's parents. Observing parental behavior is an important nursing function during this child's well-baby visit. What would the nurse expect during observation? a) Parents playing with an irritable infant b) Parents encouraging the baby's happy behaviors c) Parents ignoring the infant's fussy behavior d) Parents feeding the baby every time the baby cries

Parents encouraging the baby's happy behaviors Correct Explanation: The nurse observes the parents as they speak to their infant for encouragement of happy behaviors and comfort for crying. Parental behavior should be appropriate for the situation; a detached or irritable parent is cause for concern. The nurse would not expect to see the parents feeding the baby every time the baby cries, ignoring fussy behavior, or playing with an irritable infant. These actions do not demonstrate appropriate parental behavior

A client admitted to the health care facility for new onset of abdominal pain expresses to nurse that they were treated for gastroesophageal reflux disease in the past. In which section of the comprehensive health assessment should the nurse document this information? a) Past health history b) Review of Systems c) History of present illness d) Chief complaint

Past health history Explanation: The chief complaint is the abdominal pain. Any associated symptoms would be a part of the history of present illness. The information provided by the client about a past illnesses in the past are part of the past health history. Review of systems provides specific questions about past illnesses that might still be impacting the client

What occurs during the termination phase of an interview? a) Addressing topics that have not yet been addressed b) Planning for follow-up care c) Letting the patient know you understood all he or she has told you d) Assessing the patient's mental status

Planning for follow-up care Explanation: The main activity that takes place during the termination phase is planning for follow-up and closing the interview.

When gathering information about medication use, a nurse should ask a client about which types of drugs? a) Prescription and OTC medications b) Prescription medications only c) Over the counter (OTC) medications d) Vitamins and herbal supplements

Prescription and OTC medications Explanation: It is important to ask a client about prescription, OTC, vitamin & herbal supplements, as well as information about substance use/abuse. Many OTC and herbal supplements can interfere with the action of prescription drugs or cause untoward side effects

A client scheduled for surgery tells the nurse that he is very anxious about the surgery. What is an appropriate action by the nurse when interacting with this client? a) Mirror the client's feelings. b) Refer the client to a spiritual guide. c) Provide simple and organized information. d) Approach the client in an in-control manner.

Provide simple and organized information. Correct Explanation: The nurse should provide simple and organized information to reassure the client about the procedure and its expected outcomes. The nurse approaches the aggressive, not anxious, client in an in-control manner. The nurse refers the dying client or client with spiritual concerns to a spiritual guide. The nurse should avoid expressing anxiety or becoming anxious like the client, as it would make the client more anxious

What is the best action by a nurse when a client has difficulty describing the chief complaint? a) Wait in silence until the client can find the correct words b) Ignore the complaint & return to it at a later time in the interview c) Provide the client with a laundry list of words to choose from d) Restate the question using simple terms

Provide the client with a laundry list of words to choose from Explanation: A laundry list of descriptive terms can assist the client to describe symptoms, conditions, or feelings. The laundry list will assist the nurse to obtain specific answers & reduce the likelihood of the client perceiving or providing an expected answer. Restating the question would be useful if the client does not understand the questions being asked. Silence will not assist the client in describing symptoms but may make the situation even more uncomfortable.

In interviewing a client about substance use, a nurse asks her whether she takes any herbal supplements. Which of the following is the best rationale for asking this question? a) Taking herbal supplements may be the client's mechanism for coping with stress. b) Taking herbal supplements is an indicator that the client is concerned with maintaining her health. c) Abuse of herbal supplements can result in cardiac dysfunction. d) Some herbal supplements may interact with prescribed medications.

Some herbal supplements may interact with prescribed medications. Correct Explanation: Because many people use vitamins or a variety of herbal supplements, it is important to ask which ones and how often. These supplements and prescription medications may interact (e.g., garlic decreases coagulation and interacts with warfarin [Coumadin]). There is no indication that using herbal supplements can result in cardiac dysfunction. Taking herbal supplements may be an indicator of concern for one's health and a mechanism for coping with stress, but neither of these is as good a rationale as the one regarding interactions with prescribed medications

What is an appropriate action by a nurse when providing care for an 18-year-old with respiratory problems caused by excessive smoking? a) Suggest methods and provide resources to assist with smoking cessation b) Remind the client that excessive smoking could cause cancer c) Keep a neutral expression and avoid display of surprise d) Ask the client why he started smoking at a young age

Suggest methods and provide resources to assist with smoking cessation Explanation: The client will know that the nurse understands that it is hard to quit smoking if the nurse suggests methods available to help kick the smoking habit. The nurse should keep a neutral and friendly expression, and avoid any display of surprise or shock at the situation. A neutral, friendly expression will help the client to open up and explain to the nurse his efforts at breaking free from the habit.

A student nurse is conducting her first patient interview. The student suddenly draws a blank on what to ask the patient next. What is a useful interview technique for the student to use at this point? a) Summarization b) Transition c) Termination d) Reassurance

Summarization can be used at different points in the interview to structure the visit, especially at times of transition. This technique also allows the nurse to organize his or her clinical reasoning and to convey it to the patient, making the relationship more collaborative. It is also a useful technique for learners when they draw a blank on what to ask the patient next

A nurse is interviewing a client who uses an expression with which the nurse is unfamiliar. What is the most appropriate expression for the nurse to use to clarify the expression's meaning from the client? a) Where did you hear that expression? b) That expression is unclear to me c) Tell me what you mean by ________? d) I think that expression means ____________

Tell me what you mean by ________? Explanation: Clarification is important when the client's word choice or ideas are unclear. For example, the nurse states, "Tell me what you mean by _____." Another way to clarify is to ask, "What happens when you _____?" Such questions prompt clients to identify other symptoms or give more information so that the nurse better understands. The nurse also can use clarification when the client's history of illness is confusing. Where the client heard the expression is not an appropriate response to help clarify the expression.

An elderly client with Parkinson's disease and his wife, who appears to be much younger than he, are being interviewed by the nurse to update the client's health history. The nurse also has the client's electronic health record on her tablet computer. Earlier in the day, the nurse had spoken with the client's primary care physician, who had relayed some concerns to the nurse regarding the progression of the client's disease. Which source of biographic information should the nurse view as primary? a) The client's wife b) The physician c) The client d) The client's medical record

The client Explanation: Biographic data usually include information that identifies the client, such as name, address, phone number, gender, and who provided the information—the client or significant others. The client is considered the primary source and all others (including the client's medical record) are secondary sources. In some cases, the client's immediate family or caregiver may be a more accurate source of information than the client.

A client who only speaks Spanish is admitted to the unit. The client's sister, who speaks English, is in the room when the English-speaking nurse starts the admission assessment. Why would it be inappropriate to use the sister as an interpreter for this client? a) The client may not want her sister to know her private information b) The sister may not tell the client exactly what the nurse says c) The client's sister may not understand medical terminology d) The sister may not be there every time the nurse needs to talk to the client

The client may not want her sister to know her private information Explanation: Using children in the family, other relatives, or close friends as interpreters violates privacy laws, because clients may not want to share personal information with others. HIPAA guidelines address privacy issues such as this scenario. Even when the client gives permission for the family member to be present, an official interpreter should be present per facility policy. The other options could be true in some situations, but the priority answer addresses privacy, both the client's right to privacy, and the facility's handling of private information.

Which describes the nurse using the technique of percussion? a) The nurse detects crepitus over the individual's thorax. b) The nurse notes symmetry of the individual's thorax. c) The nurse notes resonance over the individual's thorax. d) The nurse detects rustling over the individual's thorax.

The nurse notes resonance over the individual's thorax. Explanation: The nurse uses the technique of percussion to produce sounds over various parts of the body. The nurse detects resonance over the lungs by percussing the thorax. Inspection involves smelling for odors and conscious observation of the patient's physical characteristics and behaviors, such as noting symmetry of the thorax. The nurse uses palpation to detect crepitus over the thorax by the use of touch.

While interviewing a patient, the nurse asks, "What happens when you have low blood glucose?" This type of response to the patient is used for what purpose? a) To clarify b) To restate what the patient has said c) To promote objectivity d) To summarize the conversation

To clarify Explanation: Another way to clarify is to ask, "What happens when you get low blood sugar?" Such questions prompt patients to identify other symptoms or give more information so that you can better understand the situation.

Which action by a nurse demonstrates the correct application of the principles of standard precautions? a) Wearing a gown, gloves, and mask for the physical exam b) Change gloves after each body area is examined c) Using an antiseptic hand scrub to cleanse visibly soiled hands. d) Wearing gloves when palpating the tongue, lips, & gums

Wearing gloves when palpating the tongue, lips, & gums The nurse should wear gloves when examining or touching any areas where there is the potential for exposure to blood or body fluids. Gloves are changed between tasks and procedures on the same client after contact with material that may contain a high concentration of microorganisms. Wearing a gown, gloves, and mask is not necessary for the entire physical assessment. If hands are visibly soiled, the nurse should wash with soap and water.

When trying to explore a patient's perspective on his or her illness, the question that would best determine the patient's thoughts on the cause of the problem would be a) "Why do you think you have (name the specific symptom)?" b) "What can't you do now that you could before?" c) "Has this affected your ability to work?" d) "How has this been for you?"

Why do you think you have (name the specific symptom)?

During the interview process, the nurse uses both open-ended and closed-ended questions. During what phase of the interview process does the nurse use these specific types of questions? a) Pre-interaction b) Beginning c) Closing d) Working

Working Explanation: During the working phase, the nurse collects data by asking specific questions. Two types of questions are closed-ended and open-ended questions. Each type has a purpose; the nurse chooses which type will help solicit the appropriate information. Pre-interaction, beginning, and closing are all phases in the interview process. The pre-interaction phase is prior to meeting the client, when the nurse collects data from the medical record. The information gathered from the medical record is used to conduct the client interview. The beginning phase is when introductions are exchanged, privacy is ensured, and actions are made by the nurse to relax the client. The closing phase is when a review of the interview is conducting, summarizing areas of concerns or importance, allowing the client to ask any closing questions.

A nurse assesses a client who reports the onset of a severe headache. During which phase of the nursing interview should the nurse ask the client about the history of the present health concern and the reasons for seeking care? a) Summary b) Working c) Closing d) Introductory

Working Correct Explanation: During the working phase, the nurse asks the client about the history of the present health concern and the reasons for seeking care. In the introductory phase the nurse explains the purpose of the interview and assures the client that confidential information will remain confidential. During the summary phase or the closing phase, the nurse summarizes information obtained during the working phase and validates problems and goals with the client.

The nurse is beginning a health history interview with an adult client who expresses anger at the nurse. The best approach for dealing with an angry client is for the nurse to a) refer the client to a different health care provider. b) allow the client to ventilate his or her feelings. c) offer reasons why the client should not feel angry. d) provide structure during the interview.

allow the client to ventilate his or her feelings. Explanation: When interacting with an angry client approach this client in a calm, reassuring, in-control manner. Allow him to ventilate feelings.

The nurse is interviewing a 78-year-old client for the first time. The nurse should first a) obtain biographic data. b) use medical terminology appropriately. c) assess the client's hearing acuity. d) establish rapport with the client.

assess the client's hearing acuity. Explanation: When interviewing an older client, you must first assess hearing acuity. Hearing loss occurs normally with age, and undetected hearing loss is often misinterpreted as mental slowness or confusion

The nurse is interviewing a client in the clinic for the first time. When the client tells the nurse that he smokes "about two packs of cigarettes a day," the nurse should a) tell the client that he is spending a lot of money foolishly. b) provide the client with a list of dangers associated with smoking. c) encourage the client to quit smoking. d) look at the client with a frown.

encourage the client to quit smoking. Explanation: If you are interviewing a client who smokes, avoid lecturing condescendingly about the dangers of smoking. Also, avoid telling the client that he or she is foolish and avoid projecting an attitude of disgust. This will only harm the nurse-client relationship and will do nothing to improve the client's health. The client is, no doubt, already aware of the dangers of smoking. Forcing guilt on him is unhelpful. Accept the client, be understanding of the habit, and work together to improve the client's health.

The nurse is planning to interview a client who is being treated for depression. When the nurse enters the examination room, the client is sitting on the table with shoulders slumped. The nurse should plan to approach this client by a) using a highly structured interview process. b) providing the client with simple explanations. c) offering to hold the client's hand. d) expressing interest in a neutral manner.

expressing interest in a neutral manner. Correct Explanation: When interacting with a depressed client express interest in and understanding of the client and respond in a neutral manner.

During a client interview, the nurse asks questions about the client's past health history. The primary purpose of asking about past health problems is to a) determine whether genetic conditions are present. b) summarize the family's health problems. c) identify risk factors to the client and his or her significant others. d) evaluate how the client's current symptoms affect his or her lifestyle.

identify risk factors to the client and his or her significant others. Explanation: The past health history focuses on questions related to the client's personal history, from the earliest beginnings to the present. These questions elicit data related to the client's strengths and weaknesses in his or her health history. The information gained from these questions assists the nurse in identifying risk factors that stem from previous health problems. Risk factors may be to the client or significant others.

The nurse has interviewed a Hispanic client with limited English skills for the first time. The nurse observes that the client is reluctant to reveal personal information and believes in a hot-cold syndrome of disease causation. The nurse should a) use slang terms to identify certain body parts. b) indicate acceptance of the client's cultural differences. c) remain in a standing position during the interview. d) request a family member to interpret for the client.

indicate acceptance of the client's cultural differences. Explanation: One of the most important nonverbal skills to develop as a health care professional is a nonjudgmental attitude. All clients should be accepted, regardless of beliefs, ethnicity, lifestyle, and health care practices.

For a nurse to be therapeutic with clients when dealing with sensitive issues such as terminal illness or sexuality, the nurse should have a) advanced preparation in this area. b) experience in dealing with these types of clients. c) knowledge of his or her own thoughts and feelings about these issues. d) personal experiences with death, dying, and sexuality.

knowledge of his or her own thoughts and feelings about these issues. Explanation: Be aware of your own thoughts and feelings regarding dying, spirituality, and sexuality; then recognize that these factors may affect the client's health and may need to be discussed with someone.

During an interview with an adult client for the first time, the nurse can clarify the client's statements by a) offering a "laundry list" of descriptors. b) rephrasing the client's statements. c) inferring what the client's statements mean. d) repeating verbatim what the client has said.

rephrasing the client's statements. Explanation: Rephrasing information the client has provided is an effective way to communicate during the interview. This technique helps you to clarify information the client has stated; it also enables you and the client to reflect on what was said

The nurse is interviewing a client in the clinic for the first time. The client appears to have a very limited vocabulary. The nurse should plan to a) show the client pictures of different symptoms, such as the "faces pain chart." b) use very basic lay terminology. c) have a family member present during the interview. d) use standard medical terminology.

use very basic lay terminology. Explanation: If the client appears to have a limited vocabulary, the nurse may need to ask questions in several different ways and use very basic lay terminology.

During an interview between a nurse and a client, the nurse and the client collaborate to identify problems and goals. This occurs during the phase of the interview termed a) working. b) closure. c) introductory. d) ongoing.

working. Explanation: During the working phase, the nurse elicits the client's comments about major biographic data, reasons for seeking care, history of present health concern, past health history, family history, review of body systems for current health problems, lifestyle and health practices, and developmental level. The nurse then listens, observes cues, and uses critical thinking skills to interpret and validate information received from the client.

What are the nursing goals for the introductory phase of the nurse-patient interview? (Select all that apply.) a) Responding therapeutically to the client's emotional cues. b) Establishing a trusting, respectful rapport with the patient. c) Inviting the patient to tell their story. d) Reviewing the patient's records. e) Agreeing upon the agenda for the interview.

• Establishing a trusting, respectful rapport with the patient. • Agreeing upon the agenda for the interview. Explanation: During the introduction phase of the nurse-patient interview, the nursing focus is on putting the patient at ease and establishing trust. Actions that the nurse will take during this phase of the interview process include greeting the patient, establishing rapport, and establishing the agenda for the interview. Inviting the patient's story and responding to emotional cues are actions within the working phase while reviewing the patient's records in done in the pre-interview phase

When interacting with a patient, what conveys the extent of interest, attention, acceptance, and understanding of the nurse? (Mark all that apply.) a) Restatement b) Posture c) Cultural reassurance d) Eye contact e) Gestures

• Eye contact • Gestures • Restatement Explanation: Consciously or not, the nurse sends messages through both words and behavior. Posture, gestures, eye contact, and tone of voice all convey the extent of interest, attention, acceptance, and understanding.

A nurse is gathering biographic data from a new client who is visiting the office for the first time. Which of the following pieces of data would likely be included in the biographic section of the client's health history? Select all that apply. a) 1212 South Maple St., Sylvan, VA 23236 b) Occupation: Brick mason c) Mother: Sugar L. Thompson, died 7/14/2006 from heart attack d) Head and neck: sore throat and enlarged lymph nodes e) Lamar P. Thompson f) Caucasian

• Lamar P. Thompson • 1212 South Maple St., Sylvan, VA 23236 • Caucasian • Occupation: Brick mason Explanation: Biographic data usually include information that identifies the client, such as name, address, phone number, gender, and who provided the information—the client or significant others. The client's birth date, Social Security Number, medical record number, or similar identifying data may be included in the biographic data section. The client's culture, ethnicity, and subculture may begin to be determined by collecting data about date and place of birth; nationality or ethnicity; marital status; religious or spiritual practices; and primary and secondary languages spoken, written, and read. Gathering information about the client's educational level, occupation, and working status at this point in the health history assists the examiner to tailor questions to the client's level of understanding. The information regarding the client's mother, including the date and cause of death, would appear in the family health history section. The information on the head and neck would appear in the review of systems section

Nonverbal communication is a very important aspect in nurse-client relationships. What can the nurse do to help gain trust in clients? Select all that apply. a) Use gestures intentionally to illustrate points, especially for clients who cannot communicate verbally b) Do not look the client in the eye c) Do not use facial expressions such as rolling the eyes or looking bored or disgusted d) Laugh a lot, which puts the client at ease e) Make sure that dress and appearance are professional

• Make sure that dress and appearance are professional • Do not use facial expressions such as rolling the eyes or looking bored or disgusted • Use gestures intentionally to illustrate points, especially for clients who cannot communicate verbally Explanation: The physical appearance of the nurse sends a message to the client. Thus, it is important for nurses to ensure that their dress and appearance are professional. Facial expressions should be relaxed, caring, and interested. Facial expressions common in social situations (eg, rolling the eyes, looking bored or disgusted) reduce trust. The nurse uses gestures intentionally to illustrate points, especially for clients who cannot communicate verbally. The nurse may point with a finger or gesture an action, such as pretending to drink or pointing to the bathroom.

A nurse who may be shy in social situations may exhibit excellent therapeutic communication by what? Select all that apply. a) Communicating nonverbally through facial expression b) Using touch c) Using silence d) Discussing alternative treatment options e) Giving advice

• Using silence • Using touch • Communicating nonverbally through facial expression Explanation: Because of the nurse-client relationship, the nurse in the professional role listens more than talks. Those who might be shy in social situations may exhibit excellent therapeutic communication not by talking but by communicating nonverbally through presence, facial expression, or touch. This makes giving advice and discussing alternative treatment options incorrect answers

When a client responds to a question with a "yes" or "no" answer, what appropriate responses by the nurse encourage the client to elaborate? (Select all that apply.) a) Go on b) Yes c) Okay d) I see e) Um hum

• Yes • Um hum • Go on Explanation: These responses encourage clients to say more and continue the conversation. They show clients that the nurse is interested. The nurse may nod the head or say "Um hum," "Yes," or "Go on" to cue clients to keep talking. Responses of "I see" and "Okay" do not encourage elaboration by the client and are therefore incorrect.