N206: Chapter 8 Communication
A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states, "How is she doing, since the baby's father is no help?" What is the nurse's BEST response to the neighbor? A) "New mothers need support." B) "The lack of a father is difficult." C) "How are you today?" D) "It is a very sad situation."
A) "New mothers need support." Explanation: The nurse must maintain confidentiality when providing care. The statement "New mothers need support" is a general statement that all new parents need help. The statement is not judgmental of the family's roles.
During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply. A) Group decision making B) Group leadership C) Group power D) Group identity E) Group patterns of interaction F) Group cohesiveness
A) Group decision making D) Group identity E) Group patterns of interaction F) Group cohesiveness Explanation: Solving problems involves group decision making; ascertaining that the staff completes a task on time and that all members agree the task is important is a characteristic of group identity; group patterns of interaction involve honest communication and member support; and cohesiveness occurs when members generally trust each other, have a high commitment to the group, and a high degree of cooperation. Group leadership occurs when groups use effective styles of leadership to meet goals; with group power, sources of power are recognized and used appropriately to accomplish group outcomes.
A nurse in the rehabilitation division states to the head nurse: "I need the day off and you didn't give it to me!" The head nurse replies, "Well, I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate." Instead of this exchange, what communication by the nurse would have been more effective? A) "I placed a request to have 8th of August off, but I'm working and I have a doctor's appointment." B) "I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I make an appointment?" C) "I will need to call in on the 8th of August because I have a doctor's appointment." D) "Since you didn't give me the 8th of August off, will I need to find someone to work for me?"
B) "I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I make an appointment?" Explanation: Effective communication by the sender involves the implementation of nonthreatening information by showing respect to the receiver. The nurse should identify the subject of the meeting and be sure it occurs at a mutually agreed upon time.
A nursing student is preparing to administer morning care to a patient. What is the MOST important question that the nursing student should ask the patient about personal hygiene? A) "Would you prefer a bath or a shower?" B) "May I help you with a bed bath now or later this morning?" C) "I will be giving you your bath. Do you use soap or shower gel?" D) "I prefer a shower in the evening. When would you like your bath?"
B) "May I help you with a bed bath now or later this morning?" Explanation: The nurse should ask permission to assist the patient with a bath. This allows for consent to assist the patient with care that invades the patient's private zones.
A nurse is providing instruction to a patient regarding the procedure to change a colostomy bag. During the teaching session, the patient asks, "What type of foods should I avoid to prevent gas?" The patient's question allows for what type of communication on the nurse's part? A) A closed-ended answer B) Information clarification C) The nurse to give advice D) Assertive behavior
B) Information clarification Explanation: The patient's question allows the nurse to clarify information that is new to the patient or that requires further explanation.
During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after communicating the nursing care plan. What would be appropriate nurse responses in this situation? Select all that apply. A) Fill the silence with lighter conversation directed at the patient. B) Use the time to perform the care that is needed uninterrupted. C) Discuss the silence with the patient to ascertain its meaning. D) Allow the patient time to think and explore inner thoughts. E) Determine if the patient's culture requires pauses between conversation. F) Arrange for a counselor to help the patient cope with emotional issues.
C) Discuss the silence with the patient to ascertain its meaning. D) Allow the patient time to think and explore inner thoughts. E) Determine if the patient's culture requires pauses between conversation. Explanation: The nurse can use silence appropriately by taking the time to wait for the patient to initiate or to continue speaking. During periods of silence, the nurse should reflect on what has already been shared and observe the patient without having to concentrate simultaneously on the spoken word. In due time, the nurse might discuss the silence with the patient in order to understand its meaning. Also, the patient's culture may require longer pauses between verbal communication. Fear of silence sometimes leads to too much talking by the nurse, and excessive talking tends to place the focus on the nurse rather than on the patient. The nurse should not assume silence requires a consult with a counselor.
A nursing student is nervous and concerned about working at a clinical facility. Which action would BEST decrease anxiety and ensure success in the student's provision of patient care? A) Determining the established goals of the institution B) Ensuring that verbal and nonverbal communication is congruent C) Engaging in self-talk to plan the day and decrease fear D) Speaking with fellow colleagues about how they feel
C) Engaging in self-talk to plan the day and decrease fear Explanation: By engaging in self-talk, or intrapersonal communication, the nursing student can plan her day and enhance her clinical performance to decrease fear and anxiety.
A nurse enters a patient's room and examines the patient's IV fluids and cardiac monitor. The patient states, "Well, I haven't seen you before. Who are you?" What is the nurse's BEST response? A) "I'm just the IV therapist checking your IV." B) "I've been transferred to this division and will be caring for you." C) "I'm sorry, my name is John Smith and I am your nurse." D) "My name is John Smith, I am your nurse and I'll be caring for you until 11 PM."
D) "My name is John Smith, I am your nurse and I'll be caring for you until 11 PM." Explanation: The nurse should identify himself, be sure the patient knows what will be happening, and the time period he will be with his patient.
A patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the MOST appropriate comment or question to elicit additional information? A) "Do you take two injections of insulin to decrease the complications?" B) "Most health care providers recommend diet and exercise to regulate blood sugar." C) "Most complications of diabetes are related to neuropathy." D) "What specific complications have you experienced?"
D) "What specific complications have you experienced?" Explanation: Requesting specific information regarding complications of diabetes will elicit specific information to guide the nurse in further interview questions and specific assessment techniques.
During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. Upon entering the room, what is the nurse's BEST response? A) "You need to speak to the patient quietly so you don't disturb the other patients." B) "Let me help you with your transfer technique." C) "When you are finished, be sure to apologize for your rough demeanor." D) "When your patient is safe and comfortable, meet me at the desk."
D) "When your patient is safe and comfortable, meet me at the desk." Explanation: The charge nurse should direct the patient care technician to determine the patient's safety. Then the nurse should address any concerns regarding the patient care technician's communication techniques privately. The nurse should direct the patient care technician on aspects of therapeutic communication.
A nurse enters the room of a patient with cancer. The patient is crying and states, "I feel so alone." Which response by the nurse is the most therapeutic action? A) The nurse stands at the patient's bedside and states, "I understand how you feel. My mother said the same thing when she was ill." B) The nurse places a hand on the patient's arm and states, "You feel so alone." C) The nurse stands in the patient's room and asks, "Why do you feel so alone? Your wife has been here every day." D) The nurse holds the patient's hand and asks, "What makes you feel so alone?"
D) The nurse holds the patient's hand and asks, "What makes you feel so alone?" Explanation: The use of touch conveys acceptance, and the implementation of an open-ended question allows the patient time to verbalize freely.
A 3-year-old child is being admitted to a medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents? A) The use of reflective questions B) The use of closed questions C) The use of assertive questions D) The use of clarifying questions
D) The use of clarifying questions Explanation: The use of the clarifying question or comment allows the nurse to gain an understanding of a patient's comment. When used properly, this technique can avert possible misconceptions that could lead to an inappropriate nursing diagnosis. The reflective question technique involves repeating what the person has said or describing the person's feelings. Open-ended questions encourage free verbalization and expression of what the parents believe to be true. Assertive behavior is the ability to stand up for yourself and others using open, honest, and direct communication.
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: a. "Are you allergic to any medications?" b. "Can you tell me the medications you take on a daily basis?" c. "Do you have an advanced directive or a living will?" d. "What did your health care provider tell you about your need to be admitted?"
d. "What did your health care provider tell you about your need to be admitted?"
What are the four levels of communication?
Intrapersonal Communication Interpersonal Communication Small- Group Communication organizational communication
The helping relationship (nurse-patient relationship) is ordinarily described as having three phases:
(1) the orientation phase, (2) the working phase, and (3) the termination phase.
When interacting with a patient, the nurse answers, "I am sure everything will be fine. You have nothing to worry about." This is an example of what type of inappropriate communication technique? A) Cliché B) Giving advice C) Being judgmental D) Changing the subject
A) Cliché Explanation: Telling a patient that everything is going to be all right is a cliché. This statement gives false assurance and gives the patient the impression that the nurse is not interested in the patient's condition.
A nurse caring for a patient who is hospitalized following a double mastectomy is preparing a discharge plan for the patient. Which action should be the focus of this termination phase of the helping relationship? A) Determining the progress made in achieving established goals B) Clarifying when the patient should take medications C) Reporting the progress made in teaching to the staff D) Including all family members in the teaching session
A) Determining the progress made in achieving established goals Explanation: The termination phase occurs when the conclusion of the initial agreement is acknowledged. Discharge planning coordinates with the termination phase of a helping relationship. The nurse should determine the progress made in achieving the goals related to the patient's care.
A nurse notices a patient is walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. Based on these nonverbal clues, for which condition would the nurse assess? A) Pain B) Anxiety C) Depression D) Fluid volume deficit
A) Pain Explanation: A patient who presents with nonverbal communication of a stooped gait, facial grimacing, and gasping sounds is most likely experiencing pain. The nurse should clarify this nonverbal behavior.
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply. a. The nurse keeps communication simple and concrete. b. The nurse shows patience with the client and gives the client time to respond. c. The nurse gives lengthy explanations of the care that will be given. d. The nurse communicates in a busy environment to hold the client's attention. e. The nurse maintains eye contact with the client. f. If there is no response, the nurse does not repeat what is said and takes a break.
a, b, e.
A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening? a. "You seem unsure. Tell me your concerns about your surgery." b. "I understand your confused, what do you think you should do?" c. "I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?" d. "You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure."
a. "You seem unsure. Tell me your concerns about your surgery."
A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response? a. Be silent and allow the client to continue speaking when ready. b. Smile and say, "Don't worry, I am sure the physician is doing a good job." c. Nod and say, "I agree. If I were you, I would get a new doctor." d. Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
a. Be silent and allow the client to continue speaking when ready.
A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse? a. "Don't worry about labor, I have been through it and it is not so bad." b. "There are many good medications to decrease the pain; it will not be so bad." c. "You're worried about how you will tolerate the pain associated with labor." d. "I would recommend keeping a positive attitude."
c. "You're worried about how you will tolerate the pain associated with labor."
CUS (communication tool)
communication tool to assist in effective communication related to patient safety concerns; the acronym CUS stands for I'm Concerned, I'm Uncomfortable, This is unSafe (or This is a Safety issue)
