Fundamentals test 3 (CH. 21-communication)

The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. Which of the following is the most appropriate response by the nurse to decrease the client's anxiety?

"I will start an IV that will add fluids directly to the blood stream."

A nurse pays a house visit to a client who is on total parenteral nutrition. The client expresses that he misses enjoying food with his family. What is the most appropriate response by the nurse?

"Tell me more about how it feels to eat with your family."

A female client reports to her primary care physician with aggravated chest pain. The physician orders a stress test. The client tells the nurse that she does not want to take the test and feels she should instead continue with the medication a little longer. Understanding that the client is anxious, what is the most appropriate response by the nurse?

"Tell me more about how you are feeling."

A nurse visits a female victim of sexual assault for the fourth visit. The client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse?

"Tell me more about the aspects that makes you feel as if it happened yesterday."

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 pain when it goes in, but I will be by your side throughout and will help you hold your position."

A client reports to the primary health care facility with complaints of chest pain. After the investigations and initial treatment, the client anxiously inquires if he had a heart attack. What should be the nurse's reply?

"The physician wants to monitor you and control your pain."

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 what?

"The thought of having surgery is keeping you awake."

leading questions tell you want you want to hear, for example--

"You're not going to smoke cigarettes are you?"

A nurse is examining a 3-year-old child with conjunctivitis. During the examination, the child starts crying and refuses to sit still. Which of the following statements is appropriate for the nurse tell the child?

"would you like to see my flashlight"

Intrapersonal Communication:

-(or self talk) -is the communication that happens within the individual. -This communication is crucial because it affects the nurse's behavior and has the ability to enhance or detract from positive interaction with the patient and family.

Older Adults related factors of impaired verbal communication:

-Aphasia—reduce ability to understand what others are saying -Hearing problems—prescubysis (65 and older) -Voice problems -Dysarthria

Blocks of Communication include:

-Failure to perceive the patient as a human being -Failure to listen -Changing the subject -Giving false assurance -Gossip and rumor -Aggressive interpersonal behavior (bullying)

Assertive Behavior includes the nurse:

-Having empathy -Describing ones feelings or the situation -Clarifying expectations -Anticipating consequences -having confidence -using open body posture -keeping eye contact -using "I" statements

Orientation Phase:

-Ideally begins during data gathering -Roles are clarified -the tone and guidelines for the relationship are established

Inappropriate/questions/statements that should NOT be made:

-Using clichés, is a stereotyped, trite, or pat answer. -Yes or no questions (did you have a good day) NO! NO! -Why, How questions -Probing questions (third degree questions) -Leading questions (tell me what I want to hear) "You're not going to smoke cigarettes are you?" -Giving Advice -Using judgmental comments

3 phases of a helping relationship:

-orientation phase -working phase -termination phase

_______ results in a reduced ability to understand what others are saying, to express oneself, or to be understood.

Aphasia

Related factors of Impaired verbal communication:

Decrease in ciculation to the brain Brain tumor Physical barrier Anatomic defect Cleft palate Psychological barrier Cultural differences Developmental or age related

Goals of a Helping Relationship:

Determined cooperatively Defined in terms of patient need (ex: increase independence, raise self esteem etc..)

A nurse is caring for a terminally ill client whose death is imminent. The nurse has developed a close relationship with the family. Which of the following is the most appropriate intervention?

Encourage family discussions of feelings.

5 levels of communication include:

Intrapersonal Communication Interpersonal Small group Organizational Group Dynamics

When communicating with patients nurses need to be very careful in their approach. This is particularly true when communicating using...

Medical terminology

Impaired verbal communication is an approved .....

NANDA nursing diagnosis

When caring for a psychiatric patient, a formal contract is made with the patient during which phase of the nurse-patient relationship?

Orientation phase

A nurse is caring for a client with myasthenia gravis. The client is having difficulty forming words and his tone is nasal. Which of the following is an effective communication strategy for this client?

Repeat what the client has said to verify the meaning.

The nurse is caring for a client who speaks Chinese, and the nurse does not speak Chinese. An appropriate approach for communication with this client includes what?

Using a caring voice and repeating messages frequently

The nurse has entered a client's room and observes that the client is hunched over and appears to be breathing rapidly. What type of question should the nurse first implement in this interaction?

a yes/no question

Open-ended questions/comments:

allow a wide range of responses; prevents the patient from answering with a simple yes or no.

A helping relationship is characterized by..

an unequal sharing of information. (patient shares information related to personal health problems, where as the nurse shares information in terms of a professional role.

A nurse is asking a client health-related questions during a medical assessment. The client has developed lesions on the skin and warts around the mouth. Which of the following factors affect oral communication?

attention and concentration

The transmission of information without the use of words is termed nonverbal communication, also known as _________

body language.

Group Dynamics:

can be described most simply as how individual group members relate to one another during the process of working toward group goals.

Noise are factors that distort the quality of a message and can...

can interfere with communication at any point of the process. (TV, pain, discomfort)

Clarifying questions/comments:

clarifying question allows nurse to gain understanding of patients comment. Overuse can make the patient think that nurse is not listening

________ is the foundation of society and the most primary aspect of a nurse-patient interaction.

communication

According to NANDA, Imparied verbal communication is defined as--

decreased, delayed, or absent ability to receive, process, transmit, and/or use a system of symbols

Upon assessment of a patient with multiple sclerosis, the nurse notes that the patient is difficult to understand due to an inability to produce speech sounds related to poor respiratory control and impaired movement of the lips and tongue. The nurse will document this finding on the patient's chart as:

dysarthria

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

Which qualities in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached?

empathy

Helping relationship:

exists among people who provide and receive assistance in meeting humans needs.

When assessing a client's nonverbal communication, the nurse will assess which of the following as the most expressive part of the body?

facial expressions

Confirmation of the message provides __________ that the receiver has understood the intended message.

feedback (evidence)

In an interview, you will use interviewing techniques to obtain needed information while remaining _______ in approach.

flexible

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

when making a determination about the effectiveness of a group, one studies the _______

group dynamics

It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. Which of the following is the characteristic of empathy?

identifying the clients feelings

Reflecting questions/comments:

involves repeating what the patient has said or describing the patients feelings to get them to say more

Dispositional Traits:

is a characteristic or customary way of behaving. Nurses that use the methods below are well disposed to communicate effectively.

Verbal Communication:

is an exchange of information using words, including both the spoken and written word.

Message:

is the actual physiologic product of the source. (speech, interview, chart, conversation, nursing note, etc..)

Verbal Communication depends on ______, or a prescribed way of using words so that people can share information effectively.

language. (ex: public speaking, composing signs and posters, writing for publication)

The ability to communicate is essential for _______, ______ and ______

learning, working, and social interaction.

Closed-ended questions/comments:

limits the choices of possible responses with one or two words such as yes or no.

Communication assists in meeting psychosocial needs of _____, ______, and _______

love, belonging, and self-esteem

Purpose of an interview:

major tool that can help obtain accurate thorough information

third degree questions are called ______

probe/probing questions

To be an effective communicator, the nurse needs to be considerate of the ...

receiver, and select a message that appeals to the clients interest and that requires minimal effort and time to decode.

The study of meanings of words is called ________

semantics

A helping relationship is _____

time limited

A nurse is discussing cataract treatment with a client. Which of the following statements by the nurse would be most therapeutic?

"Have you ever thought of laser surgery?"

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.

Berlo created the communication process which is-

1. source/encoder 2. message 3. channels 4. receiver/decoder

A nurse touches the patient's hand while discussing his diagnosis. This action is a(an)

communication channel

Which of the following factors is most important in the development of rapport between nurse and patient?

trust

A nurse is caring for an elderly client. What strategy should the nurse include in order to facilitate effective communication?

use active listening during communication

Sequencing questions/comments:

used to place events in chronological order to investigate cause-and-effect relationships between events

Care provided to a client following surgery and until discharge represents which phase of the helping relationship?

working phase

Which of the following activities takes place during the working phase of the nurse-client relationship? Select all that apply.

• The client participates actively in the relationship. • The client genuinely expresses his or her concerns to the nurse.

organizational communication:

-occurs when individuals and groups within an organization communicate to achieve established goals. (nurses on a practice council meeting to review unit policies)

Small group communication:

-occurs when nurses interact with two or more individuals. -They must communicate to achieve goal. (staff meetings, patient care conferences, teaching sessions, support groups)

Non-verbal communication includes:

-touch -eye contact -FACIAL EXPRESSIONS -posture -gait -gestures (thumbs up) -appearance -sounds (groaning) -silence

A nurse has developed strong rapport with the wife of a patient who has been receiving rehabilitation following a debilitating stroke. The wife has just been informed that her husband will be unlikely to return home and will require care that can only be provided in a facility with constant nursing care. The patient's wife tells the nurse, "I can't believe it's come to this." How should the nurse best respond?

"This must be very difficult for you to hear. How do you feel right now?"

The daughter of an older adult female client has asked the nurse why a urine specimen was collected from her mother earlier that morning. How can the nurse best respond to the daughter's query?

"We want to test your mother's urine to make sure she doesn't have a urinary tract infection."

A nurse is assessing a patient's nutritional intake prior to admission based upon information that indicates the patient has lost 10 pounds over the last 2 months. An appropriate therapeutic communication technique to gain information is which of the following?

"What factors have contributed to your weight loss over the last few months?"

Termination Phase:

-Conclusion of the initial agreement is acknowledged -Examine the goals did you meet them or not -Generally emotions are involved (ex:shift change, discharge, or when a nurse leaves for vacation or for employment elsewhere)

Therapeutic Communication Conversation skills should..

-Control the tone -Be knowledgeable -Confidence/honesty -Be flexible -Be clear/ concise/KISS -Avoid words with different meanings -Have an open mind -Take advantage of available opportunities

Factors that influence communication include--

-Developmental Level -Gender -Sociocultural Differences -Roles/Responsibilities -Space/Territoriality -Physical, mental, and Emotional State -Values -Environment

In the orientation phase, the nurse and the patient agree on..

-Goals -Location -Frequency -Length of contacts -Duration -Orientation to health facility

Working Phase:

-Usually the longest phase -Work together to meet the patient's needs -Nurse provides patient with assistance -Nurses role of teacher/counselor -Patients need to have a satisfactory interaction

Therapeutic Communication Listening skills--

-Verbal/non-verbal -Be alert & relaxed -Have a natural conversation -Pay attention to what he or she is saying -Think before responding to the patient -Do not pretend to listen -Listen for themes -silence -touch -humor

Factors Promoting Effective Relationships:

-Warmth/friendliness -Openness/respect -Empathy -Honesty/authenticity, trust -Caring -competence

3 characteristics of a helping relationship include:

-dynamic-- both persons are providing assistance and the person being helped are active participants to the extent each is able. -purposeful time limited-- there are specific goals that are intended to be met within a certain time period. -responsibilities--the person providing the assistance is held accountable for the outcomes.

Therapeutic Communication in the nursing process includes:

Assessing (verbal & non-verbal) Diagnosing Outcome identification and planning Implementing (Education) Evaluating (Verbal & Non-verbal)

A student nurse is attempting to improve her communication skills. Which of the following is an appropriate therapeutic communication skill?

Control the tone of the voice to avoid hidden messages.

When documenting client care, the nurse understands that the most important reason for correct and accurate documentation is which of the following?

Conveyance of information

The nurse has engaged the services of an interpreter when interviewing a client who speaks a language that the nurse does not understand. The interpreter is functioning in which role during the communication process?

communication channel

____ is the feeling of MUTUAL trust

Rapport

SBAR stands for:

Situation (i am calling about Alex, code 3232, she has a UTI) Background (mental status, skin color, on O2 or not) Assessment (this is what i think the problem is..) Recommendation (a urine test should be given)

Rapport/trust builders include--

Specific objective Comfortable environment Privacy Confidentiality Patient versus task focus Nursing observations Optimal pacing Respecting personal space

Which of the following guidelines should a nurse use when choosing a position in relation to a client during a verbal interaction?

Take note of the client's cues when choosing a position and act on these cues.

The nurse has entered a client's room after receiving a morning report. The nurse rapidly assessed the client's airway, breathing, and circulation and greeted the client by saying "Good morning." The client has made no reciprocal response to the nurse. How should the nurse best respond to the client's silence?

The nurse should ask appropriate questions to understand the reasons for the client's silence.

A nurse and an elderly client with chronic back pain are in the working phase of the nurse-client relationship. Which of the following activities occur in the working phase?

The nurse tries to avoid retarding the client's independence.

When the nurse communicates with a newly admitted patient, the nurse must pay particular attention to nonverbal behaviors. The nurse considers which of the following as nonverbal communication?

The patient's tone of voice

A nurse communicating with a patient states, "I will be changing your dressing." She is wearing sterile gloves and a mask. She is conveying a(an)

congruent relationship

An older adult client who has had a colostomy for over 10 years states, "I won't need any teaching about colostomies. I understand how to change the bag and care for my colostomy, but I'm not sure how to best clean my stoma." What does this statement indicate?

an incongruent relationship

During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking, "How many times have you been hospitalized this year for your back pain?" This is an example of which type of question?

close-ended questions

While assessing a client, the nurse notices that the client seems to be distracted from the questions being asked. The nurse attempts to identify factors that may be affecting the communication. Which of the following would the nurse identify as an internal influencing factor?

cultural background, beliefs, and experiences

a nurse should always ______ when conducting an interview

demonstrate respect

communication is the ...

heart of nursing

A _____ occurs because of a specific purpose with a specific person.

helping relationship

Channels:

is the medium the sender has selected to send the message. (may target receivers senses) --The message can be sent to the receiver through the following channels: auditory (spoken words or cues) visual (sight, observations, and perception) & kinesthetic (touch) nurses use all 3 to communicate with patients

Communication:

is the process of exchanging information and generating and transmitting meanings between two or more individuals.

Receiver/decoder:

must translate and interpret the message sent. The receiver must make an accurate decision about an accurate response.

The nurse encourages a client to participate in the communication process by using an opening remark based on observations and assessment. Which approach would be most effective for the nurse to use to promote trust?

neutral

During an annual performance review with an employee, the nurse manager does not maintain eye contact and seems concerned about the time and the next appointment. This use of communication is considered

nonverbal

Interpersonal Communication:

occurs between two or more people with a goal to exchange messages.

Source/encoder:

of the message is a person or group who initiates or begins the communication process.

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 questions

A nurse enters the client's room and introduces himself stating, "Hello, Mr. Alonso. My name is Anthony Bader. I will be your registered nurse today. I will be providing your nursing care and I will be with you until 3:30 PM. If you need anything, please call me on my phone or put your light on." He then gives the client a printed card with this information. In the helping relationship, what does this represent?

orientation phase

a helping relationship is built on the _____

patients needs (patient centered care)

Validating questions/comments:

serves to validate questions and comments (ex: nurse: at home, you have been taking both a water pill and BP pill daily. Did you take them today? ......Patient: yes, I took one of each with breakfast"

A dialysis nurse is educating a client on caring for the dialysis access that was inserted in 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. What phase of the working relationship is best described in this scenario?

the working phase

In order to provide effective nursing care, the nurse should engage in what type of communication with the patient and significant others?

therapeutic communication

__________ involves "unruffling" or clearing, congested areas of energy in the body and redirecting the energy.

therapeutic touch