Prep U / Qs -Chapter 8 - Communication
The nurse is communicating with a client following a routine physical examination. Which statement best demonstrates summarization of the appointment?
"We reviewed your plans for your new diet and medications. Do you have any other questions?" Explanation: Summarization highlights the important points of a conversation or interaction. Reminding the client that the diet plan and new medications were discussed best summarizes the appointment. The other answers do not review the topics discussed.
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?
"You're worried about how you will tolerate the pain associated with labor." Explanation: Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives.
In which situation 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. Explanation: The SBAR technique of communication has numerous applications, including nurse-physician communication surrounding acute client developments. The technique is not normally applied in client education or in communication between the health care team and patients' families.
Which nurse would most likely be the best communicator?
A nurse who easily develops a rapport with clients Explanation: Rapport, a feeling of mutual trust experienced by people in a satisfactory relationship, facilitates open communication. Advanced practice does not make an individual an effective communicator. Although being bilingual or proficient in sign language allows a nurse to communicate with more people, it does not necessarily make the communication meaningful or effective.
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client?
Approach the client with empathy and understanding and allow the client to share feelings without being judged. Explanation: Rapport is a feeling of mutual trust between nurse and client. Kindness is the quality of being friendly, generous, and considerate. Active listening and the use of silence are communication techniques, but they do not necessarily develop mutual trust between the nurse and client.
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication?
Assess how the client would like to communicate Explanation: Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge.
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?
Have you ever thought of laser surgery?" Explanation: "Have you ever thought of laser surgery?" is a therapeutic response and encourages the client to express the client's own views. Statements such as, "You should try laser surgery"; "Why don't you try laser surgery"; and "My grandfather also benefited from laser surgery" are nontherapeutic and are equivalent to giving advice.
The nurse and the physical therapist discuss the therapy schedule and goals for a client on a rehabilitation unit. What type of communication is occurring between the nurse and the therapist?
Interpersonal Explanation: The nurse and physical therapist are engaging in interpersonal communication, which occurs between two or more people with the goal to exchange messages. Intrapersonal communication, or self-talk, is the communication that happens within the individual. Small-group communication occurs when nurses interact with two or more individuals. Organizational communication occurs when individuals and groups within an organization communicate to achieve established goals.
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.
The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond. The nurse keeps communication simple and concrete. Explanation: There are several nursing actions that would be appropriate to facilitate. The nurse would maintain eye contact with the client. The nurse shows patience and gives the client time to respond. The nurse keeps communication simple and concrete. The nurse would not communicate in a busy environment because this could be distracting to the client. The nurse would not give lengthy explanations to the client regarding the care to be given. The nurse would repeat the information if no response was shared by the client.
Which statement accurately describes the concept of feedback as it pertains to the process of communication?
The sender and the receiver use one another's reactions to produce further messages. Explanation: Feedback is a person's reactions to a message that provide evidence that the person has understood the intended message. Based on one's feedback during communication, the other party can produce further messages. The other answers describe aspects of effective communication that precede feedback.
Which is an open-ended question?
Why did the health care provider prescribe this medication for you?" Explanation: Open-ended questions (e.g., "Why was this medication prescribed for you?") give the client an opportunity to express what the client understands and prevent the client from answering with just "yes" or "no" or some other one-word response. The other three responses require only a one-word response (e.g., "yes" or "no") and so are closed-ended questions.
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?
Working phase Explanation: During the working phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions. The orientation phase involves making introductions and establishing client goals. The termination phase involves evaluating client progress toward goals and concluding the relationship. There is no evaluation phase in the nurse-client relationship.
The nurse completes the admission process of a client to an acute care facility. Which statement by the nurse demonstrates the communication technique of focusing?
You are hoping to figure out the cause of your extreme fatigue during this hospital stay." Explanation: The statement "You are hoping to figure out the cause of your extreme fatigue during this hospital stay" focuses on the main problem that the client has been reporting and the goal for this admission. The other statements demonstrate the communication technique of clarifying.
A nurse touches the client's hand while discussing the client's diagnosis. This action is:
a communication channel. Explanation: A communication channel is a carrier of the message; touch can be a channel. Communication is a dynamic process, but simply touching one's hand is not. Touch is not translation--converting a message from one form to another--but is a channel for the message. Touch is a tactile, not auditory, channel.
A nurse is on lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. One of the physicians, who is in charge of the nurse's clients, points at the nurse and states, "That guy needs to get fired." The best response by the nurse would be to:
ask to speak to the physician in private and address the disrespectful remark. Explanation: When disruptive physician behavior occurs, it is best to respond assertively and confront the physician directly. If this is not possible, ask to speak to the physician in private and address any disrespectful remarks or behaviors. Nurses should factually document the occurrence of any bullying behaviors and speak to a nurse-manager if the behavior continues.
A client arrives at a crisis center in a state of bipolar mania. The client has a flight of ideas and it is difficult for the nurse to obtain an adequate intake assessment. Which statement or question will elicit the most specific information?
"Are you allergic to any medications?" Explanation: The closed question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. The only closed question among the answer options is, "Are you allergic to any medications?" All of the other answer options are open-ended questions, which would be difficult for a person in a state of bipolar mania to answer with specific, succinct, helpful responses.
The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply.
"Are you ready to get out of bed?" "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Does it hurt when I touch you here?" Explanation: The closed-ended question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed-ended questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. Closed-ended questions are often a barrier to effective communication. Asking what the client does for fun or what the client's future plans are facilitates communication between the client and the nurse.
A client has just been given a diagnosis of cirrhosis of the liver. Which statements by the nurse should be avoided because they could impede communication? Select all that apply.
"Cheer up. Tomorrow is another day." "Your doctor knows best." "Don't worry. You will be just fine in another day or two." "Everything will be all right." Explanation: A clichés© is a stereotyped, trite, or pat answer. Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Clients tend to interpret them as a lack of real interest in what they have said. For example, even though the common question "How are you?" could start a conversation, it can cause a problem if the client hearing this suspects that the nurse is not sincerely interested in how he feels. Statements such as: "Everything will be all right," "Don't worry," and "Cheer up" impede communication and foster false hope. Stating your doctor knows best can lead to powerlessness in the client. On the other hand, acknowledging that the client has just received a lot of information and that it is understandable if the client is struggling to process it all is empathetic, and offering to talk about it opens up a line of communication rather than closing it.
The client confronts the nurse, stating, "No one has come into my room to give me the pain medication I requested 2 hours ago. I am in pain!" Which response by the nurse indicates the nurse is using a "defending" communication technique?
"I have been busy with other clients that required my immediate attention." Explanation: The nurse is demonstrating defending behaviors and statements when attempting to justify the reason for not returning with a client's pain medication. This response places the client in the defensive stance as well. The nurse demonstrates belittling when indicating that the client is not feeling the degree of pain reported. The nurse is disagreeing with the client's statement which is nontherapeutic communication techniques. A more appropriate technique for the nurse to use would be to acknowledge the client's pain and administer the medication as prescribed. The nurse is not acknowledging the client's report of pain as valid when stating that "That's not true" which is inappropriate and will be detrimental to the nurse-client relationship. Informing the client that they should have reminded the nurse about the pain medication is not the client's responsibility.
A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse?
"I know this is hard for you. Is there any way I can help?" Explanation: Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. By retaining this quality, you can establish successful helping relationships without appearing cold or stern. The statement "I am so sorry you are going through this" demonstrates sympathy. Sympathy differs from empathy because it shifts the emphasis from the client to the nurse as the nurse shares feelings and personal concerns and projects them onto the client, limiting the ability to focus objectively on the client's needs. Asking about why the client is crying is part of information gathering but is not empathy. Stating that sitting in the dark will not cure cancer is an abrasive statement that may work against the nurse-client relationship.
A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question?
"I understand you have four kids; how many times have you actually been pregnant?" Explanation: The use of the clarifying question or comment allows the nurse to gain an understanding of a client's comment. In this scenario, the nurse is asking how many times the client has been pregnant. Gravida refers to the number of pregnancies, whereas para refers to the total number of live births. Confirming the client has four children is a form of validating what the client said. The age and/or term of the children does not clarify the original question asked by the nurse.
A client comes into the urgent care center to have sutures removed on an arm. The nurse finds significant crusting along the suture line. The client states not having time to get the sutures removed a week prior, as directed. The nurse soaks the crust and attempts to remove the sutures. As the nurse attempts the suture removal, the client frequently pulls the arm away and tells the nurse, "You are taking too long and it is hurting a little bit. Just pull them out and get it over with." Which statement is an example of appropriate therapeutic response?
"It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them." Explanation: Sharing information about why the removal of the sutures hurts and is taking longer is a teaching moment which helps the client make better decisions about health care. Telling the client not to wait so long for removal is not therapeutic because it diminishes the client's ability to make choices. Changing the subject is not therapeutic and is a way for the nurse to avoid listening and addressing the client's concerns. Telling the client it will not hurt if the client relaxes is an example of false reassurance.
The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client?
"It sounds as though you are most concerned about how your children will feel." Explanation: The nurse is demonstrating empathy when reiterating what the client is saying. This helps the nurse become effective at providing for the client's emotional needs while maintaining detachment. The other responses indicate that the nurse is feeling sympathy for the client, which includes feeling as emotionally distraught as the client. While this may be an unavoidable response, it may not help the client move through the grieving process as effectively.
The client is talking to the nurse about recent health problems of immediate family members and the strain the client has been under trying to care for them. The client begins to cry. What response by the nurse demonstrates the most empathy?
"Just take your time. I am listening." Explanation: The response, "Just take your time. I am listening." allows the client permission to collect thoughts while also expressing emotion and lets the client know the nurse is there for the client. Using appropriate periods of silence rather than "talking away" the client's feelings is empathetic. The response "I know how you feel" does not focus on the client's feelings. Stating "It's okay to cry" or "Take some time for yourself" suggests that the nurse is granting the client permission to experience the client's own feelings, which the client does not need.
A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response?
"Share with me the advantages and disadvantages of your options as you see them." Explanation: When it comes to treatment decisions, the nurse should avoid giving advice, thus reserving the right of each person to make one's own choices on matters affecting health and illness care. The nurse should share information on potential alternatives, promote the client's freedom to choose, and support the client's ultimate decision. Giving advice, avoidance, and providing false reassurance are all nontherapeutic forms of communication.
The health care provider has recommended the client have a surgical procedure performed. The surgery would allow the client's problem to resolve quicker. Without surgery, healing would be delayed. The client states, "I do not want the surgery done." What is an appropriate response by the nurse?
"Tell me the reason you do not want the surgery." Explanation: The nurse advocates for the client and allows the client to make his or her own choices. The best option is to explore the reason the client does not want the surgery. The reason could be related to fear, pain, or immobility after surgery. With the other options, the nurse is denying the client's rights to have an opposing decision or choice.
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask:
"Were you tired and depressed before starting the new medication?" Explanation: Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence. The symptoms the client is complaining of are common adverse effects of this drug. Sequencing can determine the cause and effect in this scenario. Clients taking metoprolol should check their blood pressure and pulse before taking their medication. Asking about the current diet or exercise regimen does not uncover the cause and effect.
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?
"You seem unsure. Tell me your concerns about your surgery." Explanation: To understand the client's perspective, the nurse uses therapeutic communication techniques to encourage verbal expression. The use of active listening facilitates therapeutic interactions. "You seem unsure" demonstrates that the nurse was actively listening and has decoded the content and feelings of the client. "Tell me your concerns about your surgery" is an open-ended statement which will allow the client to express themselves. Giving clients the opportunity to be heard helps them organize their thoughts and evaluate their situation more realistically. "I understand you are confused" and "I understand that you are not sure" are examples of rescue feelings on behalf of the nurse. Saying I understand implies the nurse has the knowledge to fix the problem, especially followed by an explorative statement. Asking the client what he or she thinks he or she should do or why the surgery is not needed will put the nurse in the position to judge the response. "Please let me know if you decide to postpone the surgery until you are no longer unsure" suggests that the client should postpone the surgery and is an example of giving advice. The nurse should not give opinions, attempt to sway a client's opinion, or avoid an uncomfortable discussion.
The nurse is communicating with a client who has been newly diagnosed with cancer. Which statement(s) by the nurse is nontherapeutic? Select all that apply.
"You will be OK. Your health care provider is an excellent surgeon." "Keep your chin up. People survive this type of cancer all the time." "Why did you not seek help when you first noticed a problem?" Explanation: "You'll be OK...." is giving false reassurance to the client. It does not recognize the client's feelings, and it discourages further discussion. "Keep your chin up...." is using a cliche and provides worthless advice. From the information at the stem of the question, the outcome for the client is not known. "Why did you not seek help..." is demanding an explanation. The word "why" puts the client on the defensive and blames the client for failure to act sooner. "This is upsetting news for you..." acknowledges the client's feelings and encourages discussion. "Have you made decisions..." also engages the client and encourages the client to discuss any decisions that have been made.
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's. Explanation: A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse's and do not represent those of the employer. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly.
The nurse should consider which client aspect as nonverbal communication?
A person communicates by gestures, facial expressions, posture, space, appearance, body movement, touch, vocal tone, volume, and rate of speech. All are examples of nonverbal communication. A client's accent, religious practices, values, and beliefs pertain to the client's culture, ethnicity, country of origin, and personal experience. They are not elements of nonverbal communication.
A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client?
Arrange for a sign language interpreter when discussing treatment. Explanation: During the planning step of the nursing process the nurse develops and prioritizes an individualized plan of care in partnership with the client, family, and others as appropriate. The client with mental or physical limitations should be included in the plan as much as possible. A sign language interpreter allows the client to participate fully in the plan of care. Consulting with the client's children is not as beneficial because it places them in the difficult position of translating while experiencing the emotional strain of the parent's illness. A TTD line can assist in communication but is not as helpful as a medical interpreter. Consulting the oncology nurse specialist is not as helpful in communicating with this client as an interpreter.
A nurse states the following to another nurse who is constantly forgetting to wash hands between clients: "It looks like you keep forgetting to wash your hands between clients. It's really not safe for your clients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech?
Assertive Explanation: The communication is an example of assertive speech. Assertive communication is the ability to stand up for oneself and others using open, honest, and direct communication. Aggressive communication involves asserting one's rights in a negative manner that violates the rights of others. Therapeutic speech is speech a nurse uses when communicating with a client that has a specific purpose or goal. Nonassertive speech would be the opposite of assertive speech, as described above.
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?
Be silent and allow the client to continue speaking when ready. Explanation: When clients are angry or crying, the best nursing response is to remain nonjudgmental, allow them to express their emotions, and return later with a follow-up regarding their legitimate complaints. Therefore, staying silent and allowing the client to continue speaking when ready is the most appropriate response in this scenario. Giving false reassurance, agreeing, giving advice, or avoiding the subject are traps that block or hinder verbal communication.
Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?
Correct response: analysis Explanation: Empathy, positive regard, and a comfortable sense of self were among the key ingredients. Empathy is an objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting yourself in another person's circumstances, and imagining what it would be like to share that person's feelings. Communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions or regard with the patient and family. Comfortable sense of self is part of the nursing confidence in caring for clients. Analysis is part of the nursing process and not the key elements of therapeutic communication.
A client has cancer, but the significant other does not want the client to know the diagnosis. The nurse demonstrates sensitivity to the significant other and works with the couple to achieve desired outcomes. What kind of behavior is the nurse exhibiting?
Empathy Explanation: An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. Sympathy is the expression of sorrow for someone's situation, involving compassion and kindness. Sympathy shifts the emphasis from the client to the nurse, as the nurse shares feelings and personal concerns and projects them onto the client. Curiosity is a strong desire to know or learn something. Empathy is perceptive aware
A nurse is discharging a client and thus terminating the nurse-client relationship. Which action should the nurse perform in this phase?
Examine goals of the relationship to determine whether they were achieved Explanation: In the termination phase, the nurse and client examine the goals of the nurse-client relationship for indications of their attainment or evidence of progress toward them. If goals were not attained, the nurse should help the client establish a relationship with a new nurse. Making formal introductions and making a contract regarding the relationship occur in the orientation phase. Providing assistance to achieve goals occurs in the working phase.
The nurse is communicating with a client who begins to cry. The nurse places a hand on the client's arm and sits quietly at the client's beside. What mode of communication is the nurse using to offer caring and comfort for the client?
Kinesthetic Explanation: There are three forms of communication channels: kinesthetic, verbal, and visual. Kinesthetic communication is the use of touch to convey emotional support for the client. The verbal mode of communication uses words to relay information, and visual communication uses gestures or actions to communicate. Body language is a broad term for nonverbal communication that allows the nurse to observe uncommunicated behaviors of the client and can include several behaviors including: touch, eye contact, facial expressions, posture, gait, gestures, general physical appearance, grooming, sound, and silence.
A nurse is calling a physician to communicate a change in the client's condition. According to the ISBARR format for handoff communication among health care personnel, which is the most appropriate way to begin the conversation?
My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital." Explanation: ISBARR was recently revised by the QSEN institute to include initial identification of the nurse and the client. The nurse should identify oneself and one's role during the initial conversation with the physician, as in the answer in which the nurse states the full name and degree. This allows the physician to understand the role of the nurse should the physician need to provide orders or instructions regarding the client. The other responses fail to identify the nurse in the beginning of the conversation or fail to adequately identify the client.
A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment?
Pull the curtain dividing the two beds. Explanation: It might not always be possible to carry on conversations alone with the client in a room, but every effort should be made to provide privacy and to prevent conversations from being overheard by others. Sometimes merely drawing the curtains around the bed in a hospital or long-term care facility, or sitting in a corner of the waiting room or lounge, can provide the sense of privacy that is so important in most interactions. It is not appropriate to ask the client in the other bed or any visitors to leave the room. Personal information should not be discussed in public thoroughfares.
The nurse is reporting to an oncoming nurse about the care of a client using the SBAR format. The nurse informs the oncoming nurse that the client should continue to have neurological checks every 2 hours and the nurse should report any alterations to the health care provider. In which section should this information be relayed?
Recommendation Explanation: This information is the recommendation of the nurse regarding the client's condition. It is not discussing background information related to the client, the situation of the client, or any assessment information related to the client.
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out during this phase of the relationship?
Reviewing health changes Explanation: During the termination phase of the nurse-client relationship, the nurse and the client review health changes and how the client has dealt with physical and emotional responses. During the orientation phase of the nurse-client relationship, the nurse and client work toward establishing trust and rapport. During the working phase of the nurse-client relationship, the nurse attends to the physical health care needs of the client and develops solutions that the client will act on.
A nurse is attempting to communicate with a client who speaks a different language and is not fluent in the nurse's language. Which nursing action would best facilitate the communication process?
Speak slowly and distinctly, but not loudly. Explanation: The best nursing action to facilitate the communication process would be to speak slowly and distinctly, but not loudly. Repeating the message multiple times would not be beneficial. Finding another way to convey the message would be more likely to be helpful. There may be cultural differences in nonverbal communication, for example, direct eye contact in some cultures is considered rude or threatening in other cultures. The use of a language dictionary could be beneficial in facilitating the conversation.
The nurse is caring for a 25-year-old client admitted to a medcial surgical unit after an emergency appendectomy. The newly admitted client has been assigned under the nurse's care. As part of the care plan, the nurse sets specific client goals. For each of the goals set by the nurse, click to specify whether it belongs to the orientation, working or termination phase.
The client verbalizes understanding of what signs indicate infection and when to contact the health care provider. ( Termination phase) The client states, "I know I have to get up and moving so I do not get pneumonia." ( Working phase) The client is able to call the nurse by name and demonstrate how to use the call light. ( Orientation phase) The client states, "Using the pillow to splint my abdomen when I cough, really helps." ( Working Phase) Explanation: The orientation phase is the initial phase of the nurse-client relationship. During this phase, specific client and nurse roles are discussed, including the duration of the therapeutic relationship. The nurse also orients the client to the room and environment as well as identify oneself by name. After the initial orientation, the client should be able to verbalize understanding of the room including being able to demonstrate how to use the call light and identify the nurse by name. The second phase of the nurse-client relationship is the working phase. Participation and cooperation between the nurse and the client are the highlights of this phase. In addiiton, verbalization of concerns and feelings also occur in the working phase. The nurse takes on the role of teacher during this phase by instructing and motivating the client to implement health-promoting activities meant to facilitate the client's ability to execute the nursing plan. The client 's statements, "I know I have to get up and moving so I do not get pneumonia," and "Using the pillow to splint my abdomen when I cough, really helps" indicates understanding of the nurse's teachings. The last phase of the nurse-client relationship is the termination phase. Evaluation of goals and termination of the therapeutic relationship occur during this phase. This can occur at the end of the nurse's shift or when the patient is discharged. The client's ability to verbalize understanding of what signs indicate infection and when to contact their physician, allows the nurse to evaluate the client's goal progression as well as assess their readiness for discharge.
A nurse and client are in the working phase of the helping relationship. What outcome statement developed by the nurse and client correlates with this phase?
The client will express feelings and concerns to the nurse. Explanation: The working phase of the nurse-client relationship is when the nurse and the client work together to meet the client's physical and psychosocial needs. The client expressing feelings and concerns demonstrates the work that is going on to meet the specific goals that are set in the orientation phase. Determining when and where they will meet is established in the orientation phase of the relationship. Identifying the goals that have been accomplished during the relationship is established in the termination phase of the relationship.
Which nursing actions would most likely help improve communication with clients and achieve a more effective helping relationship? Select all that apply.
The nurse controls the tone of voice so that it conveys exactly what is meant. The nurse makes statements that are as simple as possible, gearing conversation to the client's level. The nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations. Explanation: The following nursing actions would most likely help improve communication with clients and achieve a more effective helping relationship: The nurse controls the tone of voice so that it conveys exactly what is meant; the nurse makes statements that are as simple as possible, gearing conversation to the client's level; the nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations. The nurse attempts to remain focused on the topic at hand but must allow the client to diverge to another topic, as appropriate. The nurse must be careful not to use words that might have different interpretations than what the nurse meant. The nurse should admit a lack of knowledge to the client to avoid undermining the client's confidence in the helping relationship.
A dialysis nurse is educating a client on caring for the dialysis access that was inserted into 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. Which phase of the working relationship is best described in this scenario?
The working phase Explanation: There are three phases of a helping relationship: the orientation phase, the working phase, and the termination phase. The introduction phase is not a valid phase, yet the nurse introduces oneself during the orientation phase. The scenario defines characteristics of the working phase, during which the nurse and client work together to meet the client's physical and psychosocial needs. During the orientation phase, the nurse and client establish the tone and guidelines for the relationship . The termination phase occurs when the nurse and client acknowledge that they have met the goals of the initial agreement or that the client would be better served by another nurse or health care provider.
A nurse has developed strong rapport with the spouse of a client who has been receiving rehabilitation following a debilitating stroke. The spouse has just been informed that the client is unlikely to return home and requires care that can only be provided in a facility with constant nursing care. The client's spouse 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?" Explanation: Acknowledging the difficulty of the situation for the spouse is empathetic, and asking the spouse to elaborate on feelings may be therapeutic as well as provide insight into the spouse. Asking about the reasons underlying the care team's recommendation is less likely to be of benefit and may encourage the spouse to find fault with the recommendation. Attempting to redirect the spouse to a positive outlook at this early point is insensitive. Pointing out that the health care team has the client's best interest at heart might come across as defensive, and questioning what would help the spouse accept the situation is dismissive of the spouse's feelings and discourages the spouse from sharing feelings.
When communicating with a client, the nurse uses reflection for which purpose?
To have the client elaborate on thoughts and feelings Explanation: The reflective question technique involves repeating what the person has said or describing the person's feelings. It encourages patients to elaborate on their thoughts and feelings. Exploring helps clients express their concerns and solve their problems by investigating the situation, exploring how they feel about it, and what some alternatives might be. Focusing helps the client stay on the topic. Sequencing determines events in chronological order.
A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be:
aggressive. Explanation: Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication.
A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:
allow the client to set the pace. Explanation: It would be ineffective to rush through a list of questions when obtaining a nursing history; it is more effective to let the client set the pace. Let the client know at the beginning of the interaction if time is limited so that the client does not feel that you are rushing because of a lack of concern or personal interest. Open-ended questions do not apply to "yes or no" answers. The client should be the person answering the questions unless unable to.
Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?
analysis Explanation: Empathy, positive regard, and a comfortable sense of self were among the key ingredients. Empathy is an objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting yourself in another person's circumstances, and imagining what it would be like to share that person's feelings. Communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions or regard with the patient and family. Comfortable sense of self is part of the nursing confidence in caring for clients. Analysis is part of the nursing process and not the key elements of therapeutic communication.
The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes?
contacting the interprofessional care team to discuss alternative treatment options Explanation: Nursing responsibilities in the nurse-client relationship entail advocating on the client's behalf. For a client who does not consent to a particular type of treatment, for which there may be alternative treatments available, the nurse can establish trust in the nurse-client relationship by advocating for the client's care needs to the client's interprofessional care team. Although it is part of the nurse's scope of practice to provide client education regarding treatment interventions, this is not the action the nurse would take to establish trust with the client. Speaking to the client's family about having this discussion potentially breaches client confidentiality and would serve to decrease trust in the nurse-client relationship. It is not within the nurse's scope to recommend that the client have the cognitive capacity assessed. While it is important to ensure the client has the capability to make informed decisions about treatment, the client's refusal for treatment stems from personal beliefs, not cognitive impairment.
A nurse is caring for a client admitted to the hospital for dehydration. Which physical findings should the nurse acknowledge as nonverbal communication concerning this diagnosis?
easy wrinkling of the skin and sunken eyes. Explanation: Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone. On the other hand, a person in good health tends to radiate this healthy status through general appearance. Although prolonged capillary refill is consistent with dehydration, slow heart rate is not. Pallor may be associated with dehydration but diaphoresis is not associated with this condition. Cold intolerance and brittle nails are consistent physiologic changes seen in clients with hypothyroidism.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:
eliminate as many distractions as possible. Explanation: Factors that distort the quality of a message can interfere with communication at any point in the process. These distractors might be from the television, or from pain or discomfort experienced by the client. Visitors may remain in the room as long as the mother agrees and they do not interfere with the education session. It may also be beneficial for others to learn the care in the event that they too will be caregivers for the infant. For this reason, it is best for the client's partner to remain in the room.
The nurse is beginning an assessment on a nonverbal client. The nurse must first:
establish eye contact prior to assessing, touching, and interacting with the client. Explanation: Establishing eye contact is the first action with all clients, especially nonverbal clients, prior to touching the client. Nonverbal clients are not necessarily hard of hearing. It is always good to speak to a client in a pleasant tone of voice and not "loudly," as well as to use multiple forms of communication and to verbalize all steps of the nursing assessment when interacting with clients. These actions, however, are not the first actions.
An experienced nurse has been working with a client with heart failure. The client's lungs were clear to auscultation during the morning assessment; however, the afternoon assessment revealed bibasilar crackles and tachypnea. The nurse calls to give SBAR report to the covering health care provider. In the final step of the report the nurse should:
recommend 40 mg of furosemide be administered because the client had improvement with past administration. Explanation: SBAR, which stands for Situation, Background, Assessment, and Recommendations, provides a consistent method for hand-off communication that is clear, structured, and easy to use. The S (Situation) and B (Background) provide objective data, whereas the A (Assessment) and R (Recommendations) allow for presentation of subjective information. Discussing the situation occurs during the (Situation) component of SBAR reporting. Detailing the client's past medical history is not a component of SBAR. Providing detailed findings of the head to toe assessment does not occur during SBAR reporting.
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should:
remain honest, open, and frank. Explanation: One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice. When a client feels that a nurse is being judgmental, the client might withhold significant information. The nurse needs to develop sensitivity to the unique challenges presented by each client. A urine drug screen may eventually be ordered but is not necessary at this time. There is no evidence the client wants drug rehabilitation at this time. There is no evidence that the skin infection is secondary to the drug use.
A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should:
sit at the bedside and allow the client to explain the statement. Explanation: Clients may or may not feel able to speak freely to the nurse. Often, the signals indicating their readiness to talk are subtle. Don't miss valuable opportunities for important communication by approaching clients with a closed mind or focusing on your own needs rather than on the client's needs. Nurses who lack confidence in their own ability to meet the challenges a client presents might become defensive in response to a client's comments. Nurse defensiveness is a huge barrier to open and trusting communication. Smiling and apologizing and ignoring the client close lines of communication. Although the unit may have been busy, it is best to listen to the client express feelings.
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:
swaddling the child and gently stroking its head. Explanation: Touch is the most highly developed sense at birth. Tactile experiences of infants and young children appear essential for the normal development of self and awareness of others. It has also been found that many older people long for touch, especially when isolated from loved ones because of hospitalization or long-term care facility care. Vision, taste, and hearing are not as fully developed as touch in the neonate.
