Therapeutic Communication PrepU

A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse?

"These are normal, manageable symptoms of menopause." Diminished libido and/or dyspareunia are common symptoms associated with perimenopause. Explaining that this can be a normal finding may help to alleviate worries for the client and provide hope for management of the symptoms. The nurse should avoid telling a client "not to worry" or "talk to someone else" because these can negate client feelings and shut down communication. HRT may not be recommended for this client.

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding?

A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to moderate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible.

You are teaching the daughter how to instill ear drops into her father's ear to remove impacted cerumen. What is a priority action to teach this woman?

If irrigation or instillation of liquids is ordered, the nurse should warm the liquid to body temperature by placing the container in warm water. Cold or hot liquids cause dizziness, and the potential for injury exists if the liquid is hot. The nurse should avoid inserting the irrigating syringe too deeply so as not to close off the auditory canal. The nurse should direct the flow toward the roof of the canal, rather than the eardrum.

Which communication technique is helpful in health teaching about relevant aspects of a client's well-being and self-care?

Informing is helpful in health teaching or client education about relevant aspects of the client's well-being and self-care. Silence involves periods of no verbal communication among participants for therapeutic reasons. Reflection validates the nurse's understanding of what the client is saying and signifies empathy, interest, and respect for the patient. Humor promotes insight by bringing repressed material to consciousness, resolving paradoxes, tempering aggression, and revealing new options.

A patient with Bell's palsy says to the nurse, "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient?

Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. After the sensitivity of the nerve to touch decreases and the patient can tolerate touching the face, the nurse can suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. Facial exercises, such as wrinkling the forehead, blowing out the cheeks, and whistling, may be performed with the aid of a mirror to prevent muscle atrophy. Exposure of the face to cold and drafts is avoided.

A patient has been diagnosed with a brain tumor, a glioblastoma multiforme. The nurse met with the family after the diagnosis to help them understand that:

Surgery can improve survival time but the results are not guaranteed. The overall prognosis for this type of aggressive brain tumor is poor but surgery can improve survival time.

The nurse is caring for a client in the clinic who has come in to have an EMG done. How would the nurse prepare the client for this test?

Tell the client to expect some discomfort when undergoing a lumbar puncture, myelogram, EMG, or nerve conduction studies. There is no fluoroscopy used for an EMG. It is not necessary to lie flat after an EMG.

The nurse is providing preoperative instruction for a patient who will be having an excisional breast biopsy. The patient asks the nurse what type of bra should be used after the procedure. What should the nurse inform the patient?

The patient should wear a supportive bra after the procedure. The use of a supportive bra following surgery is encouraged to limit movement of the breast and reduce discomfort.

A client preparing to undergo a lumbar puncture states he doesn't think he will be able to get comfortable with his knees drawn up to his abdomen and his chin touching his chest. He asks if he can lie on his left side. Which statement is the best response by the nurse?

"Although the required position may not be comfortable, it will make the procedure safer and easier to perform." The nurse should explain that the knee-chest position is necessary to make the procedure safer and easier to perform. Lying on his left side won't make the procedure easy or safe to perform. The nurse shouldn't simply tell the client there is no other option because the client is entitled to understand the rationale for the required position. Reporting the client's concerns to the physician won't meet the client's needs in this situation.

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:

"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

A 30-year-old was diagnosed with amyotrophic lateral sclerosis (ALS). Which statement by the client would indicate a need for more teaching from the nurse?

"My children are at greater risk to develop this disease." There is no known cause for ALS, and no reason to suspect genetic inheritance. ALS usually begins with muscle weakness of the arms and progresses. The client is encouraged to remain active for as long as possible to prevent respiratory complications.

A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse?

"Prescriptions of this medication are generally not given because it can cause corneal problems."

Which statement made by the nurse would be a nontherapeutic response when the patient says, "I will not take pain medication when I am in pain"?

"Refusing medication can only hurt you by increasing your awareness of the pain experience." People who seek health care for a specific problem are often anxious. Their anxiety may be increased by fear about potential diagnoses, possible disruption of lifestyle, and other concerns. With this in mind, the nurse attempts to establish rapport, put the patient at ease, encourage honest communication, make eye contact, and listen carefully to the patient's responses to questions about health issues.

A patient is scheduled to receive radiation therapy for 6 weeks after her lumpectomy. The patient states she is worried about the side effects of the radiation. What can the nurse inform her about the side effects of the radiation?

"The radiation can cause some skin breakdown in the axillary folds toward the end of treatment." Generally, radiation therapy is well tolerated. Acute side effects consist of mild to moderate erythema, breast edema, and fatigue. Occasionally, skin breakdown may occur in the inframammary fold or near the axilla toward the end of treatment. Fatigue can be depressing, as can the frequent trips to the radiation oncology unit for treatment. The patient needs to be reassured that the fatigue is normal and not a sign of recurrence.

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?

"You may experience progressive deterioration in all voluntary muscles." The nurse should tell the client that muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly progressive, relatively benign form of muscular dystrophy; it usually arises before age 10.

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?

"You'll need to use the drops for the rest of your life to control the glaucoma." The client is demonstrating a lack of understanding about the condition and its treatment. The nurse needs to provide additional information to the client that the condition can be controlled but not cured. The statement about lifelong therapy would be most appropriate. Eye medications would most likely be needed for the long term, not just a few months. Surgery may be used in conjunction with medication therapy; however, neither method cures the condition. The goal of therapy is to reduce the intraocular pressure to prevent optic nerve damage. In some clients, medication may be all that is needed. In other cases, additional or combination treatment with surgery or laser procedures may be necessary.

The nurse provides care for a client who experienced a recent spinal cord injury. The client is having difficulty coping with the injury. Which action(s) should the nurse implement to address this new client issue? Select all that apply.

Actively involve the client in self-care. Offer encouragement as the client makes progress. Tell client, "It is difficult to determine the severity of your deficits so close to the injury." Encouragement can contribute to the client's resolve to put forth continued effort and involving the client in care will assist with effective coping. Until the initial trauma and swelling have resolved, assumptions about outcome are premature; however, it is appropriate to say, "It is difficult to determine the severity of your deficits so close to the injury." False reassurance is a common barrier to therapeutic communication; therefore, it is inappropriate for the nurse to state to the client, "Everything is going to be all right."

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply.

Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.

A nurse is preparing a teaching plan based on MyPlate recommendations to promote healthy nutrition for an adult. What foods will comprise half of the client's plate for a healthy diet?

Fruits and vegetables According to MyPlate, an adult should have half a plate of fruits and vegetables. Vegetables and protein do not fill half the plate. Protein and dairy do not fill half of the plate. Fruits and grains will fill more than half of the plate.

A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate?

Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying.

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do?

Take the antibiotic for 3 days as prescribed. The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.

A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker?

The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc.

Which is not a likely origination point for cardiac arrhythmias?

bundle of His

A patient had a pessary inserted for long-term treatment of a prolapsed uterus. As part of a teaching plan, the nurse would advise the patient to:

see her gynecologist to remove and clean the pessary at regular intervals. A pessary should be removed, examined, and cleaned by a health care provider at prescribed intervals. At this time, the vaginal wall should be examined for pressure points or signs of irritation.

Which of the following remains the greatest barrier to improving end-of-life care?

The greatest barrier to improving care at the end of life is the clinicians' attitude toward the terminally ill and dying. Clinicians' reluctance to discuss disease and death openly with clients stems from their own anxieties about death and misconceptions about what and how much clients want to know about their illness. Technological advances for prolonging life have led to numerous ethical issues, but these issues have affected all aspects of end-of-life care--for example, how clinicians care for the dying, how family and friends participate in care, how families prepare for terminal illness and death, and how they feel after the death of a loved one. Client and family denial may be considered a barrier, but denial often is considered a useful coping mechanism. The management of acute illness to achieve a cure reflects the sociocultural context of death and dying in America setting up a cure/care dichotomy. However the focus is shifting to include a care-focused perspective for healing.

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate?

The stable phase indicates that the symptoms and disability are under control or managed. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The comeback phase is the period in the trajectory marked by recovery after an acute period. The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?

"This type of dialysis will provide more independence." Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.

A client undergoing mastoid surgery asks the nurse about the pain following the surgery. Which response by the nurse is appropriate?

"Usually the incisional pain is mild and controlled by the prescribed medication for the first 24 hours." The incisional pain from mastoid surgery is usually mild and controlled by prescribed pain medications. The client should be taking medications routinely the first 24 hours and as needed after 24 hours. Incisional pain usually does not last 3 weeks. The client may feel a sharp shooting pain when the eustachian tube is open for 2 to 3 weeks following surgery. A constant throbbing pain may indicate an infection and should be investigated.

The nurse, a member of the health care team in the ED, is caring for a client who is determined to be in the irreversible stage of shock. What would be the most appropriate nursing intervention?

Provide opportunities for the family to spend time with the client, and help them to understand the irreversible stage of shock. The irreversible (or refractory) stage of shock represents the point along the shock continuum at which organ damage is so severe that the client does not respond to treatment and cannot survive. Providing opportunities for the family to spend time with the client and helping them to understand the irreversible stage of shock is the best intervention. Informing the client's family too early that the client will not survive would rob the family of hope and interrupt the grieving process. With the chances of survival so small, the priorities shift from aggressive treatment and safety to addressing end-of-life issues.