Module 38 - Communication
The nurse is providing care to a client who is newly diagnosed with human immunodeficiency virus (HIV). Which statements by the nurse could inhibit the development of therapeutic communication with this client? Select all that apply. A) "I am so happy today! I just found out that I got accepted into nurse practitioner school!" B) "Well, I guess your lifestyle finally caught up to you." C) "One of my cousins has AIDS. It is hard to watch him die." D) "Tell me your feelings about the diagnosis." E) "Would you like to talk about the new medications you've been prescribed?"
A) "I am so happy today! I just found out that I got accepted into nurse practitioner school!" B) "Well, I guess your lifestyle finally caught up to you." C) "One of my cousins has AIDS. It is hard to watch him die."
The nurse is providing care to a client who is diagnosed with hypertension. Which response by the nurse is an appropriate example of informational confrontation with the client? A) "I noticed you rubbing your head and your eyes. Are you hurting? Let's take your blood pressure." B) "I heard raised voices when I was coming down the hall to your room. Are you upset?" C) "It is 3 p.m. and time to take your blood pressure before I give you your medication." D) "Is the blood pressure medication making your head hurt?"
A) "I noticed you rubbing your head and your eyes. Are you hurting? Let's take your blood pressure."
The nurse completes a teaching session on wound care for a client who will require dressing changes after discharge. The nurse then evaluates the effectiveness of the teaching session and determines that more education is required. Which statement by the nurse is appropriate in this situation? A) "Let me clarify again some of the steps that are required during wound care." B) "You didn't pay attention, did you?" C) "Here, let me do it for you." D) "I don't think you understood me correctly the first time."
A) "Let me clarify again some of the steps that are required during wound care."
The nurse on third shift is handing off clients to the nurse on first shift. Which of the following statements is most important for the third shift nurse to report during this handoff? A) "The client in room 312 is complaining about a headache unrelieved by pain medication. I am awaiting a call from the physician for orders." B) "The client in room 313 ate a full meal several hours ago and is currently sleeping peacefully." C) "The client in room 315 received an enema at 2100." D) "The client in room 311 was transferred from room 212."
A) "The client in room 312 is complaining about a headache unrelieved by pain medication. I am awaiting a call from the physician for orders."
A nurse educator in a medical-surgical unit is demonstrating the use of new equipment to the rest of the nurses on the unit. After initial efforts at having the class gather closely around the models were met with discomfort and inattention, the nurse educator sets up the models in the front of the classroom. Which level of proxemics would be ideal for this situation? A) 4 to 12 feet B) 1 1/2 to 4 feet C) 12 to 15 feet D) Less than 1 1/2 feet
A) 4 to 12 feet
The nurse is caring for a client who was admitted to the emergency department with abdominal pain. The client speaks very little English and requires an emergency appendectomy. The nurse has enlisted the hospital interpreter to explain the procedure and help with informed consent. When the interpreter arrives, which action by the nurse is appropriate? A) Ask the interpreter to translate as closely as possible. B) Ask the client's family to be included in the interpreting process and exchange of information. C) Direct questions to the interpreter and not the client. D) Request that the interpreter use the same dialect as the client to promote understanding.
A) Ask the interpreter to translate as closely as possible.
When the nurse receives a telephone order from the healthcare provider's office, which guidelines should the nurse use to ensure the order is correct? Select all that apply. A) Ask the provider to repeat or spell out medication. B) Read the order back to the provider. C) Ask the provider to speak slowly. D) Know agency policy for telephone orders. E) Sign the provider's name and credentials.
A) Ask the provider to repeat or spell out medication. B) Read the order back to the provider. C) Ask the provider to speak slowly. D) Know agency policy for telephone orders.
A nurse has just been hired as a medical information system (MIS) trainer at a hospital where an electronic medical record system is being installed. The nurse has been asked to assess the security of clients' medical records. According to HIPAA's Security Rule, which recommendations by the nurse will enhance security? Select all that apply. A) Assign each staff member a unique username and password. B) Install a firewall. C) Store computer-generated worksheets in a locked vault. D) Turn monitors away from view when unattended. E) Assign each unit unique passwords.
A) Assign each staff member a unique username and password. B) Install a firewall.
The nurse is caring for a client who received analgesic medication via central line to treat pain associated with cancer. After reassessing the client's response, which section of the PIE record will the nurse use when documenting the client's care? A) Evaluation B) Progress notes C) Problem D) Intervention
A) Evaluation
Traditional client records employ which of the following documentation systems? A) Source-oriented record B) Problem-oriented medical record C) PIE model D) Focus charting
A) Source-oriented record
The nurse is providing care to a client diagnosed with end-stage renal disease. When organizing a care plan conference for this client, whom should the nurse invite to participate? A) The client's family members B) A psychiatrist C) An oncologist D) The hospital CEO
A) The client's family members
The nurse is assigned to provide care to a client with chronic obstructive pulmonary disease (COPD). Overnight, the client's oxygen saturation levels decreased and the client has been placed on oxygen by the respiratory therapist. To review specific information about the care received from the respiratory therapist, which portion of the medical record should the nurse review? A) The consultation report B) The nurses' notes C) The medication record D) The diagnostic report
A) The consultation report
The nurse is sitting in on a meeting for clients on a behavioral health unit. Which of the following characteristics of the group indicate that the group is functioning effectively? Select all that apply. A) The expertise of group members is being used. B) The group atmosphere is positive. C) Members feel satisfied with their participation. D) The group listens to the ideas of certain group members. E) The discussion focuses on all issues brought by group members.
A) The expertise of group members is being used. B) The group atmosphere is positive. C) Members feel satisfied with their participation.
The nurse is preparing to document care provided to a client during the day shift. The nurse notes that the client experienced an increased pain level while ambulating and thus required an extra dose of pain medication; took a shower; visited with family; and ate a small lunch. Which information is important to include during the oral end-of-shift reporting? Select all that apply. A) The extra dose of pain medication B) The client's visit with family C) The client's response to ambulation D) The last antibiotics given E) The client's taking a showe
A) The extra dose of pain medication C) The client's response to ambulation
A nurse is developing objectives for a charter group of nurses from a national association. Which characteristics should the nurse expect to encounter when working with this semiformal group? A) The group has a formal structure, with voluntary, selective membership and structured activities during meeting times. B) The group has a formal structure, with structured activities, leadership selection from above, and easily recognized basic objectives. C) The group has an informal structure, with voluntary, selective membership and negotiable day-to-day operating standards. D) The group has an informal structure, with superimposed rules and managers who are symbols of authority.
A) The group has a formal structure, with voluntary, selective membership and structured activities during meeting times.
A nurse is providing teaching for an inpatient support group meeting. Which group behavior indicates that the teaching was effective? A) The group members appear relaxed and interested in the topic. B) The group members are tentative in expressing their feelings. C) The group avoids discussion about their signs and symptoms. D) The group members appear self-conscious when asked questions about their condition.
A) The group members appear relaxed and interested in the topic.
The nurse is providing care for a client who is newly diagnosed with chronic obstructive pulmonary disease (COPD). In this scenario, which action by the nurse would be considered an example of therapeutic communication? A) The nurse asks appropriate questions about the client's medical history. B) The nurse closes the conversation with an anecdote about breathing. C) The nurse plans to tell the client about a COPD support group. D) The nurse bonds with the client by describing her own experiences living with COPD.
A) The nurse asks appropriate questions about the client's medical history.
A nurse is providing care to a client who is scheduled for a colonoscopy. The client requires a bowel prep prior to the diagnostic test. Which approach should the nurse use to facilitate the client's understanding of the procedure? A) Use layman's terms to explain the procedure, then ask the client to describe the procedure in her own words B) Use medical terminology when explaining the procedure to the client to ensure maximum accuracy and clarity C) Focus on intonation when describing the procedure to the client D) Speak slowly and loudly when providing client teaching about the procedure
A) Use layman's terms to explain the procedure, then ask the client to describe the procedure in her own words
A novice nurse asks the preceptor why the staff spends time talking about clients between shifts when the oncoming nurses can read the clients' charts instead. Which is the best response by the preceptor? A) "Maybe we should suggest primary nursing as an alternative." B) "Change-of-shift reporting ensures that oncoming staff know the most critical information about the clients they'll be caring for." C) "Shift changes have always been done this way." D) "You're right. Talking about clients during shift changes is a waste of time."
B) "Change-of-shift reporting ensures that oncoming staff know the most critical information about the clients they'll be caring for."
The nurse is conducting a health history on a client who is being admitted to a medical-surgical unit for the treatment of chronic pain. The client is concerned about privacy and asks why it is necessary for the nurse to ask for private information and then document it in the medical record. Which response by the nurse is most appropriate? A) "You will be able to read the record and review your care." B) "Documentation decreases the likelihood that you will have to repeat this information to others who will care for you." C) "Your family can review the record and ensure that your care is appropriate." D) "A record ensures there are no breaches of confidentiality."
B) "Documentation decreases the likelihood that you will have to repeat this information to others who will care for you."
A female nurse is caring for a 21-year-old male client with a questionable gastrointestinal blockage. The healthcare provider prescribes an enema. Which reaction by the client would the nurse anticipate when planning care? A) "May I have a visitor in the room with me for support during the procedure?" B) "I would rather have my doctor perform this procedure." C) "I don't know what an enema is." D) "I am afraid of having an enema."
B) "I would rather have my doctor perform this procedure."
The nurse is caring for a client with a new colostomy. The client has been taught how to perform colostomy care and has been successful with return demonstration to the staff. Although the client is able to perform care independently and has asked to do so, the charge nurse has instructed the nursing staff to continue performing colostomy care for this client. When addressing this issue directly with the charge nurse, which statement by a staff nurse is the most appropriate? A) "The client will change the apparatus whether you like it or not." B) "The client has been trained to change the apparatus and has expressed interest in performing this procedure independently." C) "You have no right to continue delegating this task to nurses when the client has been trained to change the apparatus." D) "I am going to tell the nurse manager that you won't allow the client to change the apparatus independently."
B) "The client has been trained to change the apparatus and has expressed interest in performing this procedure independently."
The nurse is caring for a young adult client after a cervical biopsy. The client has expressed anxiety about the results. The healthcare provider peeks into the client's room and says, "The biopsy is negative." The nurse later finds the client sobbing. Which response by the nurse is most appropriate? A) "What did the healthcare provider tell you about the biopsy?" B) "You seem upset. Do you want to talk to me about the test results?" C) "Why are you crying after getting such good news?" D) "In this case, the term 'negative' is good!"
B) "You seem upset. Do you want to talk to me about the test results?"
The nurse is documenting care in a client's medical record. The nurse provides narrative documentation only for abnormal assessment findings. Based on this information, which type of charting is the nurse using? A) Computerized documentation B) Charting by exception (CBE) C) SOAP charting D) Focus charting
B) Charting by exception (CBE)
A home health nurse is precepting a new nurse during a routine wound care visit. The new nurse is assessing the client's wound and notes that it is showing signs and symptoms of infection. The client's spouse asks the new nurse how the wound looks. The new nurse responds by stating, "It looks fine," but the new nurse's face indicates a different story. When evaluating the new nurse, the preceptor should note a need to work on which aspect of communication? A) Credibility B) Congruence C) Timing D) Clarity and brevity
B) Congruence
Which of the following terms encompasses the way a group functions, communicates, sets goals, and achieves objectives? A) Cohesiveness B) Group dynamics C) Commitment D) Member behavior
B) Group dynamics
A nurse is providing care for a client who has vocal cord damage and wants to implement strategies that will promote communication with this client. Which interventions would be appropriate? Select all that apply. A) Facing the client when speaking B) Having pen and paper on hand for the client C) Making sure that the language spoken is the client's dominant language D) Using a picture board to facilitate communication E) Employing an interpreter
B) Having pen and paper on hand for the client D) Using a picture board to facilitate communication
A nurse manager is educating staff nurses about the types and frequency of documentation required for clients being cared for in long-term care facilities. These requirements originate from which of the following laws and regulatory bodies? Select all that apply. A) Problem-Oriented Medical Record (POMR) Act B) Omnibus Budget Reconciliation Act (OBRA) C) Health Care Financing Administration (HCFA) D) Minimum Data Set (MDS) Act E) American Recovery and Reinvestment Act (ARRA)
B) Omnibus Budget Reconciliation Act (OBRA) C) Health Care Financing Administration (HCFA) E) American Recovery and Reinvestment Act (ARRA)
Which of the following barriers to communication involves asking a client for information chiefly out of curiosity rather than with the intent to assist the client? A) Challenging B) Probing C) Testing D) Rejecting
B) Probing
The nurse is caring for a client who is reporting a pain level of 8 on a 0-to-10 numeric pain scale. The nurse administers the prescribed pain medication. When the nurse re-evaluates the client 1 hour later, the client is still reporting a pain level of 8. Which action by the nurse is appropriate at this time? A) Wait for the healthcare provider to make rounds to report the problem. B) Report to the healthcare provider by telephone. C) Increase the dosage of the medication. D) Include an entry in the nursing report indicating that the medication is ineffective.
B) Report to the healthcare provider by telephone.
A nurse is caring for a client with cancer who is struggling with chronic pain. The nurse tells the client, "It is normal to feel frustrated about the discomfort." Which skill associated with the working phase of the nurse-client relationship does the nurse's statement best reflect? A) Confronting B) Respect C) Concreteness D) Genuineness
B) Respect
What are the four steps of the SBAR communication technique? A) Scenario, Basics, Analysis, and Reaction B) Situation, Background, Assessment, and Recommendation C) Scenario, Background, Analysis, and Recommendation D) Situation, Basics, Assessment, and Reaction
B) Situation, Background, Assessment, and Recommendation
The nurse is admitting a client to an inpatient psychiatric unit. The client is speaking wildly and is obviously very agitated. Which action by the nurse would be appropriate to calm the client? A) Placing the client in a private room, away from others B) Speaking to the client in a soft, calm tone C) Administering a prn medication to sedate the client D) Using short sentences when talking to the client
B) Speaking to the client in a soft, calm tone
A new nurse on a unit asks to speak to the nurse manager because several clients have complained that family members were able to hear the verbal report outside their loved one's room during nursing rounds. The nurse manager asks the nurse for suggestions that could enhance client privacy. Which suggestion by the new nurse is appropriate? A) Nursing rounds should take place in each client's room. B) The unit should be closed to family and visitors during rounds. C) Nurses should tape-record their reports outside the room. D) Clients should be allowed to choose whether a written or oral report is used.
B) The unit should be closed to family and visitors during rounds.
A nurse educator is teaching a group of students about therapeutic touch. In which situation is it appropriate to use therapeutic touch as a means of communication? A) When a client's family member is making inappropriate comments to the nurse B) When an upset spouse is alone and the client has just expired C) When speaking to a client with a history of physical abuse D) When a young male client asks a young student nurse for a hug
B) When an upset spouse is alone and the client has just expired
Which of the following statements is true with regard to monopolizing in the group setting? A) Group members who engage in monopolizing behavior do so intentionally. B) When one member of a group engages in monopolizing behavior, the other group members may become angry or frustrated with the group's leader. C) Monopolizing behavior may be motivated by anxiety or a need for attention, recognition, and approval. D) One useful strategy for dealing with monopolizing is to simply and directly interrupt the individual who is engaging in this behavior.
B) When one member of a group engages in monopolizing behavior, the other group members may become angry or frustrated with the group's leader.
Which of the following statements on the part of the nurse is an example of the communication barrier known as testing? A) "Most people have little to no pain after this type of procedure." B) "Tell me when and why you started smoking marijuana." C) "Do you think you're the only client on the unit right now?" D) "How are you still in pain after receiving both doses of medication?"
C) "Do you think you're the only client on the unit right now?"
The nurse is providing care for a client who is about to be discharged. The nurse is discussing the discharge orders with the client's primary healthcare provider. Which statement by the nurse is an appropriate example of using assertive communication? A) "Can we talk about this client prior to discharge?" B) "That new medication you prescribed for the client is ineffective." C) "I am worried about the client's blood pressure. It remains high even with the new medication." D) "Excuse me, Doctor, I think you need to do something about the client's blood pressure."
C) "I am worried about the client's blood pressure. It remains high even with the new medication."
The nurse is starting preoperative teaching when the client receives a phone call. When the call ends and the nurse resumes teaching, the client is visibly upset and begins to cry. Which therapeutic initial response by the nurse is appropriate? A) "You can deal with whatever is upsetting you once we have finished." B) "It's very important to focus on this teaching so that you will recover quickly after surgery." C) "I can see that phone call has upset you. Let's talk about why you are upset before we move on with teaching." D) "What can you do to solve the problem?"
C) "I can see that phone call has upset you. Let's talk about why you are upset before we move on with teaching."
A novice nurse is working with a client who is admitted to a medical-surgical unit. The nurse is establishing a therapeutic relationship with the client by conveying empathy. Which statement by the nurse best exemplifies empathy? A) "I wouldn't be afraid if I were you." B) "You shouldn't have done it that way." C) "You seem to be frightened by the procedure. Tell me how you are feeling." D) "I know just how you feel, because my mother has the same illness."
C) "You seem to be frightened by the procedure. Tell me how you are feeling."
A young adolescent client is in the hospital preparing for major surgery for the removal of a tumor on the kidney. The client's mother tells the nurse that she doesn't want her child to receive narcotics for postoperative pain. What is the nurse's best response? A) "Okay, I'll tell the healthcare provider not to order any. Are you sure you want to do this?" B) "The pain will be severe. Why don't we ask your child about this?" C) "Your child's pain will be severe after the surgery. Can you tell me why you feel this way?" D) "You do not have a choice of medication. Decisions involving pain relief are up to the healthcare providers."
C) "Your child's pain will be severe after the surgery. Can you tell me why you feel this way?"
The nurse is caring for a client who is having difficulty understanding the dressing changes that need to be completed in the home as part of postdischarge wound care. The client asks the nurse to demonstrate the procedure again and allow the client's spouse to perform the procedure while the nurse watches. What is the most likely outcome of this assertive request by the client? A) A slightly increased chance that the wound will become infected due to exposure during dressing changes B) Less compassionate care for the client due to the nurse's irritation by the request C) A greater likelihood that the wound will heal appropriately D) A guarantee that the spouse will change the dressings correctly
C) A greater likelihood that the wound will heal appropriately
The nurse educator is teaching a group of nursing students about the purposes of documentation and medical records. Which of the following purposes is not appropriate for the educator to include in the teaching session with the students? A) Communication B) Planning C) Employee discipline D) Research
C) Employee discipline
The healthcare provider prescribes digoxin for a client who will be discharged in the morning. When documenting the order in the medical record, which action by the nurse is most appropriate? A) Entering "digoxin, .0125 mg QD" B) Entering "digoxin, 0.0125 mg QD PO" C) Entering "digoxin, 0.0125 mg, once daily by mouth" D) Entering "digoxin, 1 pill each day"
C) Entering "digoxin, 0.0125 mg, once daily by mouth"
Use of flow sheets would be most appropriate during which phase of the nursing process? A) Evaluation B) Diagnosis C) Implementation D) Planning
C) Implementation
The nurse is caring for an older adult client in a long-term care facility. Which behavior by the nurse conveys physical attending when communicating with this client? A) Facilitating and taking action when needed B) Maintaining a proper social distance when speaking with the client C) Leaning toward the client during conversation D) Being concrete about actions that need to be taken during client care
C) Leaning toward the client during conversation
What is the first phase in the therapeutic nurse-client relationship? A) Introductory phase B) Working phase C) Preinteraction phase D) Anticipatory phase
C) Preinteraction phase
A nurse case manager spends the morning in a peer discussion and the afternoon in an ad hoc quality management committee meeting that is led by the hospital administrator. Which two types of groups has the nurse case manager participated in? A) Camaraderie group and information group B) Work group and administrative group C) Primary group and secondary group D) Support group and governance group
C) Primary group and secondary group
Four groups of nurses are attempting to determine which methods are most effective for teaching patients about proper self-care. Which of these groups is least likely to arrive at a successful decision in a timely manner? A) The group that launches a pilot project to determine which teaching methods are most effective B) The group that uses scenario planning to evaluate the potential results of various teaching methods C) The group that uses trial and error to gauge the effectiveness of various teaching methods D) The group that uses a decision tree to visualize the potential results of various teaching methods
C) The group that uses trial and error to gauge the effectiveness of various teaching methods
Which of the following statements by the nurse is an example of the therapeutic communication technique of offering self? A) "Would you like to talk with me about your emotions right now?" B) "I'm not sure I understand. Please tell me more about the situation." C) "I don't know the answer to your question, but I will check with the physician." D) "I'll stay here with you until your family arrives."
D) "I'll stay here with you until your family arrives."
The nurse is caring for a school-age client who is scheduled to have major heart surgery the next morning. The nurse enters the room to administer a medication and finds the client crying. Which response by the nurse is most therapeutic? A) "Would you like some toys from the playroom?" B) "I'm going to go get the doctor." C) "You shouldn't cry. You are not in pain." D) "It is okay to cry. I know this is scary."
D) "It is okay to cry. I know this is scary."
A nurse is teaching a client about a dressing change that should be done three times per day. The client is from a culture that is "present oriented." Based on this data, at which times should the nurse tell the client to perform the dressing changes? A) At whatever times the client selects, as long as they are 8 hours apart B) At 9 a.m., 3 p.m., and 9 p.m. C) At whatever times the client selects, as long as the dressing is changed three times each day D) After breakfast, lunch, and dinner
D) After breakfast, lunch, and dinner
Which of the following situations is an example of countertransference in the group setting? A) After failing at an assigned task, the members of a group place all blame for this failure on a single group member. B) A group member reveres the group's leader, largely because the leader possesses many similarities to the member's mother, whom he adores. C) The members of a group become so caught up in the group's current beliefs and actions that they fail to recognize simple changes that would greatly improve the group's efficiency. D) The leader of a group distrusts one of the group members solely because the member reminds him of his ex-wife.
D) The leader of a group distrusts one of the group members solely because the member reminds him of his ex-wife.
Handoff communication, or the transfer of data during transitions in care, includes an opportunity to ask questions, clarify, and confirm the information being passed between sender and receiver. What is the main objective for ensuring effective communication during a client handoff? A) To avoid lawsuits B) To make sure all documentation is complete C) To facilitate quality improvement D) To ensure client safety
D) To ensure client safety
