prepU CH8: communication

A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client?

"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." -The nurse should provide correct knowledge as well as reassurance. Thoracentesis is a painful procedure and it is important for the client to sit still to avoid injuring the pleura. The nurse should reassure the client that the nurse will be present during the procedure and help the client throughout. Likewise, the nurse should avoid giving false reassurance by saying that the procedure will be painless. Additionally, the nurse should abstain from stating reasons that could scare the 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 -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.

Which is a skill appropriate to use in therapeutic communication?

Control the tone of the voice to avoid hidden messages. -Conversation skills used in therapeutic communication include controlling the tone of one's voice so that exactly what is intended is conveyed and not any hidden message. Periods of silence have an important role in conversations because they allow for reflection. The nurse should avoid using cliches, and the conversation should be flexible.

The nurse is providing care to an older adult client who has visual and hearing deficits. What action by the nurse is appropriate to help with communication?

Identify oneself by name and title with each entry into the client's room. - To facilitate communication with an older client who has visual and hearing deficits, the nurse identifies oneself by name and title each time the nurse enters the client's room. This assists with the orientation of the client who can place the interaction into proper perspective. The nurse does not remove one's face mask. The face mask is to minimize the risk for COVID for both the nurse and the client. The nurse with permission of the client would decrease the volume of the television set, or even turn the television set off, so as to not compete with the television program. This will facilitate hearing. People with hearing deficits have difficulty distinguishing simultaneous sounds from each other. The nurse will call the client by the client's preferred name. This demonstrates respect for the client. The client's name preference may not be the client's first name.

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. -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.

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. -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.

A nurse enters the client's room and begins the process of establishing a nurse-client relationship. The nurse introduces oneself and informs the client how long the nurse will be caring for the client. What additional statement does the nurse need to communicate with the client?

"Let me know if you have concerns regarding your care." -The nurse-client relationship focuses on the client, is goal-directed, and has defined parameters. The orientation phase consists of introductions and the establishment of an agreement between the nurse and the client about their mutual roles and responsibilities. This is accomplished by the nurse asking if the client has any concerns about the care. The nurse would not work to meet the nurse's needs, give personal information to the client, nor provide false reassurance to the client.

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." -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.

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 -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 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. -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.

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?" -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 unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to:

have group members confront the dominant member to promote the needed team work. -Effective groups have members who are mutually respectful. If a group member dominates or thwarts the group process, then the leader or other group members must confront the member to promote the needed collegial relationship. Planning a secret meeting does not solve the underlying issue. Picking a team leader who is not the dominant member will not address the dominance issue. A written warning would be inappropriate; a verbal communication is what is required among the team.

What nursing care behavior by the nurse engenders a client's trust in the nurse?

A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. -It is important to remember that helping relationships are professional relationships. Telling a client not to worry about the test because others have not had problems with it undermines trust by belittling the client's concerns. A nurse that answers the client's questions while documenting or defers the questions to the oncoming nurse gives the impression that the client's questions or concerns are not important. Answering the client's questions while making eye contact instils trust by showing that the nurse is competent to answer the questions and cares about the client in their care.

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. -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.

The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?

Encouraging elaboration -Encouraging elaboration involves making simple statements that indicate active listening and comprehension on the part of the nurse and that prompt the client to continue talking. This technique helps the client to describe more fully the concerns or problems under discussion. Clarification involves asking a follow-up question about a statement made by the client to clear up some point that the nurse is not sure about or to elicit more specific details. Reflection and restatement involve the nurse repeating back to the client a comment made by the client to ensure that the nurse has correctly heard or understood the client.

A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?

Orientation phase -During the orientation phase, the nurse discusses with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the nurse and client acknowledge that the agreement on which the relationship is based is concluding. There is no evaluation phase of the nurse-client relationship (evaluation is the final step in the nursing process).

The nurse makes a contract with the client during which phase of the nurse-client relationship?

Orientation phase -The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase.

A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation?

The client stares at the floor and states, "I feel fine." -It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, in the scenario in which the client stares at the floor while claiming to feel fine, the nurse should investigate further because of the incongruence between the client's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication is effective and no further investigation is warranted.

The nurse meets with the client to teach self-administration of low molecular weight heparin. During the initial part of the training the client shakes the head and asks the nurse to repeat the instructions. What action demonstrates that the nurse has assessed the client's communication abilities?

The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe. -During the initial phase of the nurse-client relationship the nurse assesses the client's verbal and nonverbal communication. Shaking the head and requests to repeat what has been said points to a hearing deficiency. Facing the client, speaking slowly and clearly, and providing a visual demonstration is effective for communicating with individuals with a hearing impairment. Making a mental note to repeat instructions is a poor nursing action regardless of the communication difficulties of the client, because the nurses failed to let the client know the plan to repeat the instructions. Stopping the instruction and getting a home health nurse to administer the medication demonstrates that the nurse interpreted the client's communication as unwilling or as an inability to self-administer. This misinterpretation may result in an unnecessary healthcare expense. The nurse asking the client if he or she is worried demonstrates that the nurse is ignoring or not paying attention to the client's communication abilities.

A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:

involve the child's stuffed animal in the educational session. -Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy. The use of music, art, and interior decorations might help put the client at ease. A client with newly diagnosed human immunodeficiency virus (HIV) infection will find it difficult to discuss sexual history or genital warts in an area that lacks privacy. A toddler might find it easier to communicate if a parent, favorite stuffed animal, or blanket is nearby. The parent should not be asked to leave the room and this may cause panic or anxiety in the child. A 3-year-old child will not be able to read written materials. Showing the child the catheter may frighten the child.