(HA Ch 3) PrepU - Interviewing and Communication
The principle of confidentiality is of paramount importance in the nurse-patient relationship. When should you inform the patient of with whom his or her information will be shared? a) At the beginning of the interview b) When the patient asks c) Whenever it seems appropriate d) At the end of the interview
a) At the beginning of the interview At the start of the interview the patient should be told with whom the information will be shared.
A nurse is preparing to assess a client who is new to the clinic. When beginning the collection of the client database, which of the following actions should the nurse prioritize? a) Establishing a trusting relationship b) Identifying potential health problems c) Making clinical inferences d) Determining the client's strengths
a) Establishing a trusting relationship It is essential for the nurse to develop trust and rapport with the client to elicit accurate and meaningful information. This trust is the focus of the interview and must be developed in the initial phase of the interview. Determining the client's strengths, identifying health problems, and making inferences occur during the working phase of the interview.
Which of the following questions is most useful in the assessment of a client's diabetes management? a) "Are you staying vigilant with your blood sugar monitoring?" b) "You check your sugars before each meal, don't you?" c) "Are you still using your glucometer 4 times a day?" d) "What is your routine for checking your blood sugar these days?"
d) "What is your routine for checking your blood sugar these days?" Answer D is an open-ended question, while the other answers are leading questions that elicit yes-no responses.
A clinic nurse has reviewed a new client's available health record and will now begin taking the client's health history. Which of the following questions should the nurse ask first when obtaining the health history? a) "What is your major health concern at this time?" b) "Are you generally fairly healthy?" c) "Do you have adequate health insurance coverage?" d) "Did you bring all your medications with you?"
"What is your major health concern at this time?" Asking the question about the client's major health concern assists the client to focus on the most significant issues and answers the nurse's question "why are you here?" or "how can I help you?" The nurse may inquire later on about the client's health insurance, but not if it is adequate. Asking if the client is fairly healthy is a closed-ended question that doesn't allow the client to verbalize concerns. Asking about medications would be appropriate later on during the interview when discussing the medications that the client takes
The nurse is preparing to assess a female client's activities related to health promotion and maintenance. Which question would provide the most objective and thorough data? a) "Could you describe how you perform self-breast exams?" b) "Do you always wear your seatbelt when driving?" c) "Do you use condoms with each sexual encounter?" d) "How much beer, wine, or alcohol do you drink?"
a) "Could you describe how you perform self-breast exams?" Asking the client to describe self-breast examination is an open-ended question that allows the client to verbalize openly about the activity and provides the nurse with information that allows determination of correctness of technique. Asking about wearing a seatbelt, how much alcohol the client drinks, or using condoms with sexual activity are closed-ended questions that would provide information of one or two words.
The nurse is preparing to interview a client with a documented history of mental illness. Which question should the nurse use to begin this interview? a) "Have you ever had a problem with mental or emotional illness?" b) "When was the last time you talked with a psychiatrist?" c) "What medication do you take for your depression?" d) "Have you considered counseling for your mental problems?
a) "Have you ever had a problem with mental or emotional illness?" The nurse should begin by asking a non-threatening open-ended question such as "have you ever had a problem with mental or emotional illness?" Asking specifically about medication for depression assumes the client has a history of depression. Asking about talking with a psychiatrist or counseling may cause the client to become defensive.
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) 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. b) Allow impatience to show so that the client picks up on nonverbal cues that the appointment needs to end. c) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview. d) Allow the client to speak uninterrupted for the duration of the appointment.
a) 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. 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.
A client comes to the emergency department wanting to be examined for the symptom of chest pain. While listening to the client describe his symptom in more detail, the nurse says "Go on," then later "Mm-hmmm." This is an example of which of the following skilled interviewing techniques? a) Continuers b) Empathic response c) Nonverbal communication d) Echoing
a) Continuers This is an example of the use of continuers. Continuers can be posture, actions, or words that encourage the client to say more.
When interviewing a patient with a language barrier, it is best to use a family member to help interpret so the patient has a level of comfort with the process. a) False b) True
a) False Recruiting family members or friends to serve as interpreters can be hazardous—confidentiality and cultural norms may be violated, meanings may be distorted, and transmitted information may be incomplete. Untrained interpreters may try to speed up the interview by telescoping lengthy replies into a few words, losing much of what may be significant detail.
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) History of present illness c) Review of Systems d) Chief complaint
a) Past health history 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.
A nurse is interviewing a client who seems anxious. Which nonverbal communication by the nurse helps to facilitate a relaxed environment for the client during the interview process? a) Portraying a neutral and friendly expression b) Sitting back with crossed arms during the interview c) Wearing casual, neat, and comfortable clothes d) Ensuring that there are no periods of silence
a) Portraying a neutral and friendly expression The nurse should portray a neutral and friendly expression throughout the assessment and appear to be understanding and concerned. This will help the client to open up and provide necessary information regarding his or her health status. The client expects to see a health professional; the nurse should wear a laboratory coat with nametag and credentials clearly visible. The nurse should allow periods of silence during the interview to allow the client to reflect and organize thoughts; this facilitates more accurate reporting. The nurse should not sit back with crossed arms during the interview, as this may cause the client to think that the nurse is not interested in the client's health condition.
During a client interview, the nurse uses nonverbal expressions appropriately when the nurse a) avoids excessive eye contact with the client. b) uses touch in a friendly manner to establish rapport. c) remains expressionless throughout the interview. d) displays mental distancing during the interview.
a) avoids excessive eye contact with the client. Avoid extremes in eye contact. Some clients feel very uncomfortable with too much eye contact; others believe that you are hiding something from them if you do not look them in the eye. Therefore, it is best to use a moderate amount of eye contact.
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) "You work at a computer a lot, don't you?" b) "Do you perform any sustained or continually repetitive motions with that arm?" c) "I recommend that you change your posture while working at the computer." d) "When did the pain start?"
b) "Do you perform any sustained or continually repetitive motions with that arm?" 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. Likewise, "You work at a computer a lot, don't you?" is a leading question, as it encourages the client to answer in the affirmative. The question, "When did the pain start?" is a close-ended question; it will elicit more information from the client but is not an example of inferring.
A 71-year-old woman has been admitted to the hospital for a vaginal hysterectomy, and the nurse is collecting subjective data prior to surgery. Which statement by the nurse could be construed as judgmental? a) "How often do your adult children typically visit you?" b) "You must quit smoking because it affects others, not only you." c) "How would you describe your feelings about getting older?" d) "Your husband's death must have been very difficult for you."
b) "You must quit smoking because it affects others, not only you." Saying that smoking is harmful to others and telling the client that she must quit forces a sense of guilt on the client. The statement may be seen as "preaching," without focusing on assisting the client to attain optimal health. Asking how often the adult children visit or how the client feels about getting older focuses on information gathering. The statement about the husband's death being difficult is plausible and acknowledges the client's feelings.
A nurse assesses a client with regard to nutritional habits, use of substances, education, and work and stress levels. The nurse recognizes this as what type of information? a) Personal health history b) Lifestyle and health practices profile c) History of present health concern d) Family health history
b) Lifestyle and health practices profile By assessing the client with regard to nutritional habits, use of substances, education, and work and stress levels, the nurse expects to obtain a lifestyle and health practices profile. To determine the history of present health concerns, the nurse should ask questions relating to the onset, duration, and treatments, if any have been conducted on the client, for the present health concern. The questions related to personal health history assist the nurse in identifying risk factors that stem from previous health problems. Family health history helps the nurse to identify potential risk factors for the client.
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 promote objectivity b) To clarify c) To summarize the conversation d) To restate what the patient has said
b) To clarify 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.
The nurse is preparing to assess an adult woman's activities related to health promotion and maintenance. Which question should the nurse ask to obtain the most objective and thorough assessment data? a) "Do you use condoms with each sexual encounter?" b) "Do you always wear your seatbelt when driving?" c) "Could you describe how you perform self-breast exams?" d) "How much beer, wine, or alcohol do you drink?"
c) "Could you describe how you perform self-breast exams?" Asking the client to describe self-breast examination is an open-ended question that allows the client to verbalize openly about the activity and provides the nurse with information that allows determination of correct technique. Asking about wearing a seatbelt, how much alcohol the client drinks, or using condoms with sexual activity are closed-ended questions that would provide information of one or two words.
A client states, "My wife died two months ago today." Which of the following responses would be most appropriate? a) "You probably must be sad." b) "What did she die of?" c) "How does that make you feel?" d) "Are you feeling sad, depressed, angry, or upset?"
c) "How does that make you feel?" The client's statement about his wife's death provides the nurse with an opportunity to gather information about the client's current state. Asking the open-ended question, "How does that make you feel?" would be most appropriate to obtain key information. Asking what the wife died from is a closed-ended question that ignores the client's feelings. Telling the client that he probably feels sad is imposing the nurse's personal values on the client. Asking the client the laundry list of feelings would be demeaning and doesn't allow the client to put his feelings into his own words.
How does a nurse indicate to a client that their concerns are not worth discussing? a) By being empathetic b) By being sympathetic c) By providing false reassurance d) By giving unwanted advice
c) By providing false reassurance By providing false reassurance, the nurse unconsciously indicates to clients that their concerns are not worth discussing. Empathy is a therapeutic response to a client and is a positive interaction. Being sympathetic and giving unwanted advice are nontherapeutic responses, but they do not tend to imply that the client's concerns are not worth discussing.
The nurse uses the mnemonic OLD CART when assessing a client's symptoms. Which letter represents the area of the symptom and if it radiates? a) O b) D c) L d) C
c) L The letter L represents the location of the symptom and if it radiates to another body area. The C represents the characteristic symptoms that are occurring. The D represents the duration of the symptom. The O represents the onset of the symptom.
Which action should a nurse implement when assessing a nonnative client to facilitate collection of subjective data? a) Avoid any eye contact with the client. b) Speak to the client using local slang. c) Maintain a professional distance during assessment. d) Ask one of the client's children to interpret.
c) Maintain a professional distance during assessment. When assessing a nonnative 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; 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 children to interpret during the interview may actually impair the assessment process. In addition, health care institutions often have specific policies regarding interpreters that you must be aware of prior to using an interpreter.
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) Approach the client in an in-control manner. c) Provide simple and organized information. d) Refer the client to a spiritual guide.
c) Provide simple and organized information. 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.
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 client's medical record c) The client d) The physician
c) The client 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. An example would be an older adult client's wife who has kept the client's medical records for years or the legal guardian of a mentally compromised client. In any event, validation of the information by a secondary source may be helpful.
During the client interview, the nurse asks specific questions such as "What were you doing when the pain started?" or "Was the pain relieved when you rested?" In what phase of the interview is the nurse involved? a) Closing b) Beginning c) Working d) Pre-interaction
c) Working During the working phase, the nurse collects data by asking specific questions. Two types of questions are closed-ended and open-ended. Each type has a purpose; the nurse chooses which type will help solicit the appropriate information. The pre-interaction phase is prior to meeting with the client. The nurse review the client's medical records to collect important data. The beginning phase is the phase when introductions are exchanged and the purpose of the interaction is explained to the client. The closing phase is a time for summarizing information shared with the client and assessing any learning deficits.
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) offer reasons why the client should not feel angry. c) allow the client to verbalize his or her feelings. d) provide structure during the interview.
c) allow the client to verbalize his or her feelings. When interacting with an angry client approach this client in a calm, reassuring, in-control manner. Allow him to ventilate feelings.
A client's spouse answers the interview questions and will not leave the examination room. What should the nurse suspect be occurring with the client? a) mental health disorder b) low self-esteem c) physical abuse d) cognitive disorder
c) physical abuse Physical abuse should be considered if the partner tries to dominate the interview and will not leave the room. The spouse's behavior does not suggest low self-esteem or a cognitive or mental health disorder.
The nurse is preparing to complete a comprehensive assessment of a newly admitted client. Why is the nurse completing this type of assessment? a) assesses symptoms of one body system b) establishes routine care needs c) provides a baseline for future assessments d) addresses specific concerns
c) provides a baseline for future assessments A comprehensive assessment provides a baseline for future assessments. A focused assessment addresses specific concerns, establishes routine care needs, and assesses the symptoms of one body system.
A nurse knocks and enters a patient room, makes introductions to the patient and visitors, and explains to the patient that she would like to conduct an interview so a plan of care can be completed. Which statement by the nurse would be most appropriate? a) "Barbara, I am going to conduct an interview so I would like to ask your visitors to leave so we can have some privacy." b) "I see you have visitors. I need to ask that they step out to the lobby for about 30 minutes so I can ask you some questions in private." c) "Mrs. Smith, I need to ask your visitors to leave so you and I can talk for about 30 minutes." d) "Mrs. Smith, I would like to conduct an interview with you but I see you have visitors. I will come back in about 30 minutes so you can visit before you and I sit privately to talk."
d) "Mrs. Smith, I would like to conduct an interview with you but I see you have visitors. I will come back in about 30 minutes so you can visit before you and I sit privately to talk." Recognizing visitors but setting a time for returning to discuss privately gives everyone time to talk and visit but does not cause a long delay for the important interview.
Upon entering an exam room, the client states, "Well! I was getting ready to leave. My schedule is very busy and I don't have time to waste waiting until you have the time to see me!" Which response by the nurse would be most appropriate? a) "No one is forcing you to be here, and you are free to leave at any time." b) "Would you like to report your complaints to someone with power?" c) "Our schedule is very busy also. We got to you as soon as we could." d) "You're certainly justified in being upset, but I am ready to begin your exam now."
d) "You're certainly justified in being upset, but I am ready to begin your exam now." When the nurse encounters an angry client, it is best to acknowledge the feelings of the client in a calm, reassuring, and in-control manner. Telling the client that the schedule is busy and that no one is forcing him or her to be there do not acknowledge the client's feelings. Inviting the client to "report your complaints to someone with power" deflects the complaint inappropriately.
The nurse is conducting a patient interview and responds to the patient in a way that encourages the patient to more completely describe his or her problems. What is this called? a) Clarification b) Focusing c) Restatement d) Promoting elaboration
d) Promoting elaboration Encouraging elaboration (facilitation) is a technique that assists patients to more completely describe difficulties. You use responses that encourage patients to say more and continue the conversation. This shows patients that you are interested.
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) Closing b) Pre-interaction c) Beginning d) Working
d) Working 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.
While interviewing a client for the first time, the nurse is using a standardized nursing history form. The nurse should a) read the questions verbatim from the form. b) ask leading questions throughout the interview. c) ask the client to complete the form. d) maintain eye contact while asking the questions from the form.
d) maintain eye contact while asking the questions from the form. Establish eye contact when the client is speaking to you but look down at your notes from time to time.