Taylor Ch 8 PrepU

The client is being discharged, and the nurse observes the client crying. What is the nurse's most appropriate response?

"Would you like to talk about anything before you go home?" The nurse should initiate a conversation with the client to determine the reason why the client is crying. Using a general, open-ended question will help with this goal. The nurse should not assume the client is in pain or scared. Although discharge teaching is appropriate for this client, this is not the appropriate response for a client who is crying. Assessing the client for pain is appropriate after trying to initiate a conversation with the client.

Which is a skill appropriate to use in therapeutic communication?

Control the tone of the voice to avoid hidden messages.

Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse?

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 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.

A nurse is caring for a client with a diagnosis of metastatic lung cancer. The nurse finds the client sitting in a chair while staring out the window. What statement by the nurse communicates concern and caring about the client?

"I can imagine you have many concerns about your health. Tell me what is on your mind." Offering false assurances by telling the client he or she will be fine or okay is not therapeutic. Giving advice such as telling the client to talk to friends and family focuses on the nurse's experiences and opinions and not on the client's needs or concerns. A client may believe he or she must do what the nurse says, even though the advice might not work well for the client. Empathy and the simple action of asking what is on the client's mind opens up lines of communication for the client to express feelings.

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?"

A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication?

"Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you."

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. 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 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 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.

A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult:

an audiologist. A nurse who suspects a speech, language, or hearing problem should refer the client to a speech-language pathologist or audiologist. A speech-language pathologist is a professional educated in the study of human communication, its development, and its disorders. An audiologist is a professional educated in the study of normal and impaired hearing. An ophthalmologist is a medical doctor who specializes in the treatment of eye disorders. An optometrist has a practice doctorate and focuses on vision. A clinical psychologist is a behavioral health expert.

Each of the following facilitates a therapeutic nurse-client relationship except:

closed-ended questions. Rephrasing, reflection, and active listening are essential for accurate assessment and interventions.

A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique?

giving 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." 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 and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point?

Being sensitive to the client's emotional barriers The nurse should try to establish a good rapport with the client and use therapeutic communication. In doing so, the nurse should be sensitive to all needs of the client-including physical and emotional. The degree to which clients are physically comfortable influences their ability to communicate. Once rapport is established, the nurse and client can communicate about pain management options, although perhaps not in great detail, as the client may not be able to tolerate lengthy explanations. The nurse sharing the nurse's own family and personal history of back pain takes the focus off of the client and is not sensitive to the client's needs. Telling the client that back surgery will likely alleviate pain completely is providing false assurance, as this is not necessarily true.

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 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 family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation?

empathy The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.

When caring for a psychiatric client, a nurse would make a formal contract with the client during which phase of the nurse-client relationship?

orientation phase In the psychiatric setting, 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 used as a therapeutic tool to help a client develop more insight and control over behavior. The working phase consists of the nurse and client working together to achieve the client goals established in the orientation phase. The termination phase consists of evaluating the client's progress toward meeting the goals and concluding the relationship. There is no intimate phase in the nurse-client relationship.

Which is an open-ended question?

"Why did the health care provider prescribe this medication for you?" 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.

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 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

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?" 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 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." 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.

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?" 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.

The nurse is caring for a client who had a stroke with residual affective aphasia. What is an effective method(s) for the nurse to communicate with the client? Select all that apply.

-provide the client with a tablet or whiteboard to attempt communication -patiently await the client's responses after asking question -have the client point to common phrases or spell with alphabet letters on a laminated form There are several methods that the nurse can use to communicate with a verbally impaired client. Creativity with methods will include offering the client a whiteboard to write down responses if able or to make requests. Giving the client a laminated form so that the client may be able to point to letters of the alphabet or commonly used phrases may be helpful. The client is not hearing impaired so there is no need to speak loudly. The nurse should be patient while waiting for responses and not rush the client through conversation or answers to questions asked.

A nurse touches the client's hand while discussing the client's diagnosis. This action is:

a communication channel. 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.