Exam 1: Communication Practice 30 Questions

After a client is treated for a spinal cord injury, the healthcare provider informs the family that the client is a paraplegic. The family asks the nurse what this means. Which explanation should the nurse provide? 1. lower extremities are paralyzed 2. upper extremities are paralyzed 3. one side of the body is paralyzed 4. both lower and upper extremities are paralyzed

1 rationale: Both legs and generally the lower part of the body are paralyzed in paraplegia. There is no term to describe only upper extremities affected; all parts below an injury are affected. One side of the body paralyzed describes hemiplegia. The paralysis of both lower and upper extremities describes quadriplegia.

A parent tells a nurse at the clinic, "Each morning I offer my 24-month-old juice, and all I hear is 'No.' What should I do? I know she needs fluid!" What is the best response by the nurse? 1. offer the child a choice of two juices 2. distract the child with a favorite food 3. offer the child the glass in a firm manner 4. allow the child to see the parent getting angry

1 rationale: Children who are expressing negativism need to have a feeling of control. One way of achieving this within reasonable limits is for the parent or caregiver to provide a choice of two items instead of forcing one on the child. Distracting the child with a favorite food will not achieve the goal of giving fluids. Offering the child the glass in a firm manner will probably not be successful with a toddler. Allowing the child to see the parent getting angry will complicate the situation and further inhibit the child's willingness to take fluids.

A client on her first prenatal clinic visit is at 6 weeks' gestation. She asks how long she may continue to work and when she should plan to quit. How should the nurse respond? 1. what activities does your job entail 2. how do you feel about continuing to work 3. most women work throughout their pregnancies 4. usually women quit work at the start of their third trimester

1 rationale: More information is needed before the nurse can give a professional response. Although it is important to ascertain the client's feelings about continuing to work, at this time she is seeking information. Although it is true that most women work throughout their pregnancies, more information is needed before the nurse can respond. It is misinformation to state that usually women quit work at the start of the third trimester.

A client who has peripheral arterial disease of the lower extremities tells the nurse, "I walk so slowly that no one wants to walk with me." What is the best response by the nurse? 1. "A vascular rehabilitation program may help you." 2. "You should be sitting with your feet elevated, not walking." 3. "Try again tomorrow because maybe you will have a better day." 4. "They are not good friends if they are not willing to walk with you."

1 rationale: Peripheral vascular rehabilitation includes exercise and walking programs that encourage new growth of vessels around the obstructed artery; this may improve peripheral perfusion and the ability to walk; eventually, walking with friends may be introduced into the walking program. Inactivity is contraindicated; elevation of the legs diminishes peripheral arterial circulation. The response "Try again tomorrow because maybe you will have a better day" provides false reassurance. The response "They are not good friends if they are not willing to walk with you" is an opinion that should be avoided; it does not focus on the client's need to improve walking ability.

A client with a diagnosis of obsessive-compulsive disorder is frequently late for appointments because it takes so much time each day to complete a ritualistic handwashing routine. What is the most therapeutic nursing intervention? 1. Accepting the client's ritual in a matter-of-fact manner without criticism 2. Encouraging the client to speed up the ritual so appointments can be met on time 3. Discouraging the client from washing the hands so frequently to prevent skin breakdown 4. Letting the client know how angry others become when the handwashing holds up activities

1 rationale: Responding to behavior in a matter-of-fact way prevents reinforcing the behavior; allowing time for the ritual will help keep the client's anxiety from increasing. Attempts to speed up ritualistic behavior will probably increase the client's anxiety. Attempts to discourage ritualistic behavior often increase anxiety. Disparaging the client may decrease self-esteem and increase anxiety and guilt, thereby intensifying the handwashing routine.

The parent of a child with a tentative diagnosis of attention deficit-hyperactivity disorder (ADHD) arrives at the pediatric clinic insisting on getting a prescription for medication that will control the child's behavior. What is best response by the nurse? 1. "It must be frustrating to deal with your child's behavior." 2. "Have you considered any alternatives to using medication?" 3. "Perhaps you're looking for an easy solution to the problem." 4. "Let me teach you about the side effects of medications used for ADHD."

1 rationale: Stating that it must be frustrating acknowledges the parent's distress and encourages verbalization of feelings. Asking whether any alternatives have been considered is insensitive to the parent's feelings; it may be more appropriate later, when the parent's stress has diminished. Although the parent may be looking for an easy answer to the problem, this response is confrontational and may close off communication. Asking to teach the parent about the side effects of ADHD medications is insensitive to the parent's feelings; it may be more appropriate later if medication is prescribed and health teaching is started.

A 40-year-old multigravida's pregnancy is confirmed at 8 weeks' gestation. She says, "I can't wait another 2 months for an amniocentesis to find out whether my baby has a chromosomal anomaly like my first child." The nurse responds that she can have chorionic villus sampling (CVS) between the tenth and twelfth weeks; what is true about this test if it is performed before this time? 1. The test can cause fetal anomalies. 2. The results are not as accurate. 3. The information it provides is inadequate. 4. It must be done with the use of laparoscopic surgery.

1 rationale: The American Congress of Obstetricians and Gynecologists recommends that CVS not be performed before 9 weeks' gestation and should be performed between 10 to 12 weeks. If performed before 9 weeks' gestation, it has the potential of interfering with organogenesis. The test, if successfully performed, is 100% accurate, and it provides enough information for a diagnosis. A laparoscopic procedure is not necessary, because CVS is performed either by means of transcervical catheter aspiration or transabdominal needle aspiration.

A client that has a diagnosis of bone cancer is being prepared for the first radiation treatment. As the nurse begins the treatment, the client starts crying, stating, "I'm so discouraged." What is the nurse's best response? 1. Tell the client, "It's difficult to deal with your diagnosis and treatment." 2. Complete the preparation and tell the client, "We can talk about this later." 3. Explain the therapy and reinforce that it will only cause a little discomfort. 4. Allow the client to be alone for a few minutes so the client can regain composure.

1 rationale: The correct response focuses on the client's feelings of despair and provides the opportunity to talk about them. Leaving the client alone abandons the client and leaves the client with no support. Avoiding a pressing problem misses an opportunity for discussion of feelings. Explaining the therapy and saying it will only cause a little discomfort focuses on the nurse's interpretation of the problem, not the client's.

The nurse is performing a neurologic assessment on a client and is completing the Glasgow Coma Scale (GCS). What components make up this assessment tool? Select all that apply. 1. best verbal response 2. best pupillary response 3. best motor response 4. best eye-opening response 5. best cognitive response

1, 3, 4 rationale: The GCS is a common way of determining and documenting level of consciousness that scores verbal response, motor response, and eye-opening response. The lowest score is 3, which indicates a totally unresponsive client; a normal GCS score is 15. Pupillary and cognitive responses are not part of the GCS assessment.

After assessing a client, the nurse anticipates that the client has a chalazion. Which statement made by the client helps the nurse reach this conclusion? 1. "I have severe pain in my eyes." 2. "I am unable to tolerate bright light." 3. "I always feel something in my eyes." 4. "I get an itching sensation in my eyes."

2 rationale: A chalazion is the painless inflammation of a sebaceous gland in the eyelid; a client with chalazion reports light sensitivity and excessive tearing. A hordeolum is an infection of the eyelid sweat glands that leads to painful areas on the skin surface of the eyelid. Entropion is an eyelid disorder in which the client always feels a foreign body in the eyes. Keratoconjunctivitis sicca or dry eye syndrome is a condition in which the client may experience a foreign body sensation and burning and itching eyes.

After several interactions with a client, the nurse at the mental health clinic identifies a pattern of withdrawal and nonparticipation in situations requiring communication with others. In which area should the nurse expect the client to have difficulty? 1. personal identity 2. social interaction 3. sensory perception 4. verbal communication

2 rationale: Characteristics of clients with problems with social interaction include avoidance of others, problematic patterns of interaction, and an inability to establish or maintain stable supportive relationships. Withdrawal from others is not a characteristic of individuals with difficulties involving personal identity. These clients usually exhibit an inability to distinguish between the self and nonself. Withdrawal from others is not a characteristic associated with clients who have alterations in sensory perception. A client with impaired sensory perception demonstrates altered processing of sensory stimuli and an exaggerated or distorted response to stimuli. Withdrawal from others is not a characteristic of clients who have difficulty communicating with others. A client who has problems communicating has a decreased ability to receive, process, or transmit communication.

What must the nurse understand about breaks with reality such as those experienced by clients with schizophrenia? 1. Extended institutional care is necessary. 2. Clients believe that what they feel that they are experiencing is real. 3. Electroconvulsive therapy produces remission in most clients with schizophrenia. 4. The clients' families must cooperate in the maintenance of the psychotherapeutic plan.

2 rationale: Failure to accept the client and the client's fears is a barrier to effective communication. Today mental health therapy is directed toward returning the client to the community as rapidly as possible. Electroconvulsive therapy is not the treatment of choice for clients with schizophrenia. Family cooperation is helpful but not an absolute necessity.

Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis? 1. takes estrogen therapy 2. receives long-term steroid therapy 3. has a history of hypoparathyroidism 4. engages in strenuous physical activity

2 rationale: Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Estrogen promotes deposition of calcium into bone which may prevent, not cause, osteoporosis.

A nurse is teaching a group of parents whose school-aged children have cystic fibrosis about ways to help their children achieve optimal growth and development. The nurse encourages a high-calorie diet. What other important detail of the diet should be included in the teaching? 1. low protein 2. moderate fat 3. high calcium 4. high potassium

2 rationale: Moderate fat is recommended because of the need for increased calories in response to growth and development requirements. A high-protein, not a low-protein, diet is recommended to overcome protein maldigestion. A high-calcium diet is not indicated in cystic fibrosis. Unless the potassium level is low, a high potassium intake is contraindicated because it may contribute to a dangerous increase in the serum potassium level that could result in the development of cardiac dysrhythmias.

Which nurse manager's behaviors and outcomes denote the qualities of transformational leadership? 1. nurse manager 1 2. nurse manager 2 3. nurse manager 3 4. nurse manager 4

2 rationale: Nurse manager 2 exhibits transformational leadership by challenging established processes and questioning the way things have been done in the past. This also includes thinking creatively about new solutions to old problems. Nurse manager 1, who uses a quid pro quo system, is demonstrating transactional leadership. Nurse manager 3, who takes no input from subordinates, also demonstrates transactional leadership. Likewise, nurse manager 4, who rewards the employees for high performance and penalizes them for poor performance, is engaging in transactional leadership.

A nurse overhears an unlicensed assistive personnel (UAP) talking with a client about the client's marital and family problems. Which statement by the UAP would the nurse recognize as providing false reassurance? 1. "I agree; I think you should get a divorce." 2. "Everything will be fine; just wait and see." 3. "You should be glad that you have such a loving family." 4. "In the scheme of things, you do not have a major problem."

2 rationale: Saying that everything will be fine provides false hope. Agreeing with the client is an example of offering approval. Commenting on how a client should feel is an example of being judgmental. Implying that the problem is minor is an example of minimizing.

A client with the diagnosis of an antisocial personality disorder responds to limit-setting by a nurse by saying, "You sure do look messy today." What is the most appropriate response by the nurse? 1. dont you feel well today 2. i get the feeling you're angry with me 3. i really didn't think anyone would notice 4. do you think that was a nice thing to say to me

2 rationale: The response "I get the feeling you're angry with me" helps the client focus on feelings rather than emphasizing the current unacceptable behavior. The response "Don't you feel well today?" gives the client an alibi for unacceptable behavior. By saying "I really didn't think anyone would notice," the nurse is becoming defensive rather than dealing with the problem directly. The response "Do you think that was a nice thing to say to me?" points out the behavior in a negative way.

A client with schizophrenia uses the word "worriation" when talking with the nurse. How should the nurse respond? 1. by correcting the pronunciation of the word 2. by asking for clarification of the word's meaning 3. by ignoring its use while interacting with the client 4. by telling the client to use words that everyone can understand

2 rationale: This is an example of a neologism, a self-coined word whose meaning is known only to the client. It is not a mispronunciation. The word's meaning must be explored. The use of a neologism should not be ignored, because the word usually has significance to the individual who is using it. Telling the client to use words everyone else can understand is a demeaning response that may cut off communication.

The nurse is planning to teach a client with heart failure about the signs and symptoms of cardiac decompensation. What clinical manifestations should the nurse include? Select all that apply. 1. weight loss 2. extreme fatigue 3. coughing at night 4. excessive urination 5. difficulty breathing

2, 3, 5 rationale: Fatigue is caused by a lack of adequate oxygenation of body cells caused by a decreased cardiac output. As the cardiac output decreases, pulmonary congestion increases, resulting in pulmonary edema; coughing, especially when lying down, and blood-tinged sputum occur. Auscultation reveals crackles and rhonchi. Dyspnea is associated with pulmonary edema that occurs as cardiac output decreases and pulmonary congestion increases. Weight gain, not loss, occurs as fluid is retained by the kidneys. Fluid retention, not diuresis, occurs because of decreased circulation to the kidneys, resulting from decreased cardiac output.

When providing preoperative teaching, what should the nurse focus primarily on? 1. Helping the client and family decide if surgery is necessary 2. Providing emotional support to the client and family 3. Giving minute-by-minute details of the surgery to the client and family 4. Providing general information to reduce client and family anxiety

4 rationale: The primary role of the nurse during preoperative teaching is to provide general information about the surgical experience and what to expect before and after surgery. Helping the client and family decide if surgery is necessary is not an appropriate intervention for the nurse. Emotional support is important and would be included as part of providing general information to reduce client and family anxiety. It is also not appropriate for the nurse to describe minute-by-minute details of the surgery unless the client and family request this information, at which time the surgeon should answer the questions.

A nurse teaches a client with asthma about her illness during pregnancy. Which statement by the client indicates that the nurse's teaching has been effective? 1. "Prednisone is safe to use during pregnancy." 2. "My asthma will get worse as my pregnancy progresses." 3. "I can use my albuterol inhaler if it's absolutely necessary." 4. "I will need to have a Cesarean to prevent a severe attack during labor."

3 rationale: Albuterol is classified as a pregnancy category C medication. It is not known whether albuterol poses risks to the human fetus; however, it may be used if its benefits outweigh the potential risks. Prednisone is also classified as a pregnancy category C medication. It is not recommended during pregnancy unless absolutely necessary because of its many adverse effects. During pregnancy asthma symptoms ease because of the increased production of corticosteroids. Labor will not precipitate an attack of asthma. A Cesarean birth is not necessary for this reason alone.

A client is admitted with a diagnosis of premature labor. The nurse discovers that the client has been using heroin throughout her pregnancy. What is the most appropriate action for the nurse to take? 1. Notify the nurse manager of the unit. 2. Inform no one because all client information is confidential. 3. Inform the client's primary healthcare provider. 4. Alert the hospital security department, because heroin is an illegal substance.

3 rationale: The fetus of a heroin-addicted mother is at risk for serious complications such as hypoxia and meconium aspiration. It is important to notify the primary healthcare provider of the client's heroin use, because this information will influence the care of the client and newborn. This information is used only in relation to the client's care. With the client's consent, it may be shared with other social service or health agencies that become involved with the client's long-term care. The nurse manager of the unit may be notified, because it relates to the care of the client and her newborn. Client information is confidential, and only necessary staff should be privileged to such information. Hospital security would only be notified if actual illicit substances were discovered on hospital premises.

A nurse becomes aware of an older client's feeling of loneliness when the client states, "I only have a few friends. My daughter lives in another state and couldn't care less whether I live or die. She doesn't even know I'm in the hospital." How should the nurse interpret the client's communication? 1. As a call for help to prevent the client from acting on suicidal thoughts 2. As a manipulative attempt to persuade the nurse to call the daughter 3. As a reflection of depression that is causing feelings of hopelessness 4. As a request for information about social support groups in the community

3 rationale: This statement provides clues that the client feels no one cares, so there is no reason the client should care. These feelings are common in depression. The clues presented should not lead the nurse to conclude that the client is looking for help to prevent suicidal activities, is attempting to manipulate the nurse, or is looking for information about community social support groups.

Before an amniocentesis, both parents express anxiety about the fetus's safety during the test. Which nursing intervention is most appropriate in promoting the parents' ability to cope? 1. initiating a parent-primary healthcare provider conference 2. reassuring them that the procedure is safe 3. explaining the procedure, step by step 4. arranging for the farther to be present during the test

3 rationale: expect during the procedure will help allay their fears and encourage their cooperation. The nurse should be able to provide information and interpretation of procedures for clients; a delay in answering questions may increase a client's concerns. Amniocentesis is a low-risk procedure; however, some complications may occur. If the father is uninformed, viewing the procedure may increase his anxiety, even though his presence may be comforting to the mother.

During a group therapy session, after several members relate traumatic incidents that happened during the week, a client says with a smile, "Things haven't gone well in my life this week either." It is most appropriate for the nurse to what? 1. Ask the client to share what has happened this week. 2. Make a note of the incongruity of the client's message but remain silent. 3. Comment, "This seems to have been a bad week for several of our members." 4. Say to the client, "You say things have been bad this week, but you're smiling."

4 rationale: "You say things have been bad this week, but you're smiling" is an open-ended, nonjudgmental response that points out incongruity between the client's verbal and nonverbal communication. Asking the client to share, remaining silent but making a note of the incongruity, or noting that it has been a bad week for several of the group's members will not help the client recognize the incongruity.

A client says, "Since my husband died I've got nothing to live for. I just want to die." The nurse hears the nursing assistant say, "Things will get better soon." What does the nurse identify this response as? 1. offering advice 2. belittling the client 3. changing the subject 4. providing false reassurance

4 rationale: False reassurance is an effort to be supportive, often involving the use of clichés, and is not based in fact. Offering advice tells the client what to do; clients should be encouraged to solve their problems. Belittling statements demean the client or minimize client concerns. The nursing assistant's statement did not change the subject.

The registered nurse is teaching a group of student nurses about the role of the nurse as a leader. Which statement by a student nurse indicates effective learning? 1. "The nurse manager has a plan for identification of charge nurses." 2. "The nurse executive need not be aware of information on succession planning." 3. "The primary goal of the nurse executive is leadership within and outside the workplace." 4. "The goal of the nurse manager is to develop a shared vision of the future with direct care nurses."

4 rationale: The goal of a nurse manager as a leader is to develop a shared vision of the future with direct care nurses. The nurse manager ensures that the day-to-day elements of the workplace are being performed correctly. The nurse executive has a plan for identification of charge nurses and should be aware of information on succession planning. The primary goal of the nurse executive is leadership within the workplace.

A client tells a mental health nurse about hearing a man speaking from the corner of the room. The client asks whether the nurse hears him, too. What is the nurse's best response? 1. "What is he saying to you? Does it make any sense?" 2. "No one is in the corner of the room. Can't you see that?" 3. "Yes, I hear him, but I can't understand what he's saying." 4. "No, I don't hear him, but it probably upsets you to hear him."

4 rationale: The statement "No, I don't hear him, but it probably upsets you to hear him" points out reality, recognizes the client's feelings, and prevents the nurse from becoming involved in the client's hallucination. The response "What is he saying to you? Does it make any sense?" is nontherapeutic; it supports and focuses on the hallucination. The response "No one is in the corner of the room. Can't you see that?" is an attempt to argue the client out of feelings by denying they exist. The response "Yes, I hear him, but I can't understand what he is saying" is nontherapeutic; it supports and focuses on the hallucination.

Phenytoin 75 mg twice daily is prescribed for a school-aged child with a seizure disorder. What instruction will the nurse include when teaching the parents about activities to limit the consequences of long-term phenytoin therapy? 1. Administer the medication between meals. 2. Watch for a reddish-brown discoloration of urine. 3. Supplement the diet with high-calorie foods and encourage fluids. 4. Provide oral hygiene, including gum massage and flossing of the teeth.

4 rationale: These procedures reduce the risk for gingival hyperplasia, a side effect of phenytoin. This drug is strongly alkaline and should be administered with meals to help prevent gastric irritation. Discoloration of the urine may occur during drug excretion; it does not cause physiologic problems. Avoiding overeating and overhydration may result in better seizure control.

A nurse needs to explain a procedure to an adolescent with the use of the analogy instructional method. Which of these actions should the nurse take? Select all that apply. 1. demonstrating the procedure to the client 2. verbally explaining the procedure to the client 3. posing a pertinent problem for the client to solve 4. using images to describe the procedure to the client 5. asking the client about previous experience with the procedure

4, 5 rationale: While using analogy instruction method, the nurse should provide verbal instructions with familiar images that make complex information more real and understandable to the client. The nurse should follow the rule of knowing the client's past experience. The nurse uses demonstration as an instructional method when teaching the adolescent client about psychomotor skills such as preparation of a syringe, bathing an infant, crutch walking, or taking a pulse. When using preparatory instruction as the instructional method, the nurse should verbally tell the client about the procedure. The nurse using the simulation instruction method should pose a pertinent problem or situation for the client to solve.