BNS (VNSG 1323) CH. 7 STUDY QUESTIONS
Name the four roles that nurses perform in nurse-client relationships.
1. Caregiver 2. Educator 3. Collaborator 4. Delegator
A palliative care nurse possesses numerous skills that have enhanced the nurse-client relationship and communication in the past. One of these skills that has benefited previous clients is affective touch. Before using this technique, the nurse must consider: A) The client's culture B) The client's diagnosis C) The client's prognosis D) The institutional policies
Answer: A Affective touch has different meanings to different people depending on how they were raised and their cultural background. The client's diagnosis and prognosis are relevant variables, but these are less likely to influence the nurse's appropriate use of affective touch. Most institutions do not have explicit policies that govern the use of affective touch.
What are the three phases of the nurse-client relationship?
Introductory phase, working, and terminating.
The nurse educator on a busy medical unit that serves a diverse population is discussing the importance of therapeutic nurse-client relationships with a group of recent nursing graduates. What principle should the nurse educator promote? A) View each client as a unique individual with unique needs and priorities. B) View each client on the unit in light of the client's medical diagnosis and necessary treatment. C) Aim to minimize differences in the care that client's receive in order to promote justice. D) Remember that there is a wide gap between nurses' knowledge and the learning needs of clients.
Answer: A A therapeutic nurse-client relationship is more likely to develop when the nurse treats each client as a unique person and respects the client's feelings. It is important not to view clients as simply a medical diagnosis. Inequalities in care are inevitable and are often justified by clients' differing needs. There may not be a divide between nurses' levels of knowledge and the learning needs of a particular client.
Which qualities in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached? A) Empathy B) Commiseration C) Sympathy D) Kindness
Answer: A Empathy refers to intuitive awareness of what the client is experiencing. It helps the nurse perform activities and remain emotionally neutral. Sympathy means feeling as emotionally distraught as the client. If the nurse sympathizes with the client, the nurse may feel equally disturbed, and performance may be affected. Kindness and commiseration also have an emotional component attached to them.
A discouraged client says, "I'm sure this surgery won't help any more than the others." What is the best initial nursing response? A) "You're saying that you doubt you will improve." B) "Do you want to talk to the surgeon again?" C) "I'd recommend a more positive attitude." D) "Of course it will, you'll be up and around in no time."
Answer: A Paraphrasing is a therapeutic communication technique by which the nurse lets the client know empathetically that he or she has understood both the content and the feelings of the client's statement. The nurse avoids any emotional support or involvement by offering to arrange contact with the surgeon. Giving advice and disagreeing with the client are nontherapeutic forms of communication.
A nurse on a subacute geriatric ward is working with a male client who has a diagnosis of Alzheimer disease. How can the nurse best enhance therapeutic communication with this client? A) Give the client plenty of time to make responses to questions that the nurse asks. B) Ask the client to paraphrase or summarize the nurse's statements. C) Ask the client frequently if the client understands what the nurse is saying. D) Avoid assessing the client unless the client has a trusted family member nearby.
Answer: A There are numerous techniques that the nurse can implement to enhance communication with cognitively impaired clients. One of these techniques is waiting long enough for a response while the client processes the information. It is unnecessary to wholly avoid communication when the client is alone. Asking for understanding is not a guarantee of comprehension. It may occasionally be necessary to ask the client to summarize an important concept or statement, but this is not a frequently used communication technique and has the potential to frustrate the client.
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? A) "Share with me the advantages and disadvantages of your options as you see them." B) "It is a minimally invasive surgery with rapid recovery time, so you will do fine." C) "You should follow your physician's recommendation and have the surgery." D) "When you see the physician this morning, request more information about the surgery."
Answer: A When it comes to treatment decisions, the nurse should avoid giving advice, thus reserving the right of each person to make his or her own choices on matters affecting health and illness care. The nurse shares information on potential alternatives, promotes the client's freedom to choose, and supports the client's ultimate decision. Giving advice, avoidance, and providing false reassurance are all nontherapeutic forms of communication.
What is the best nursing response when an 82-year-old client with Alzheimer's disease says she is looking forward to a visit from her mother later today? A) "Your mother has been deceased for year." B) "Tell me more about your mother." C) "Let me call and check on your mother." D) "When did you last see your mother?"
Answer: B Asking the client to talk about her mother is a form of reminiscing. It can serve as a distraction from the belief that her mother will visit. Telling the client that her mother is deceased may upset the client and lead to an argument with the nurse. By telling the client that he or she will call reinforces the client's belief that her mother's visit will still be forthcoming. A client with Alzheimer's disease is not likely to remember the last time her mother was seen.
A nurse caring for a client who was recently diagnosed with metastatic lung cancer finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy? A) "Don't worry, I have seen lots of people with cancer do fine." B) "I see you are upset. Would you like to talk?" C) "Do you want me to call someone for you?" D) "I am sorry to hear you have cancer."
Answer: B Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Empathy helps nurses become effective at providing for the client's needs while remaining compassionately detached. Sympathy, avoidance, and giving false reassurance are all nontherapeutic forms of communication.
A nurse is conducting an admission assessment of a client who will be receiving treatment for a kidney infection. To foster therapeutic conversation, which action should the nurse take? A) Avoid silence during the conversation. B) Remove as many distractions from the interaction as possible. C) Sit one to two feet away from the client. D) Avoid directly discussing the client's kidney infection.
Answer: B The nurse can take several actions to enhance communication, including eliminating distractions. Silence can have a therapeutic purpose, and most individuals prefer two to three feet of personal space. It is unnecessary to avoid direct reference to the client's health problem.
A 2-year-old client has a high fever of unknown origin. Which of the following is the nurse correct to delegate to a nursing assistant? A) Administer an aspirin suppository to reduce the child's fever. B) Give the toddler a Popsicle or other fluid every 30 minutes. C) Call the laboratory for the results of diagnostic tests. D) Listen to the child's lungs for sounds of congestion.
Answer: B The nurse delegates tasks within the nursing assistant's legal scope of job performance. Administering medications, collaborating with laboratory personnel about diagnostic test results, and performing physical assessments are nursing responsibilities. The nurse could delegate those to another licensed nurse or a nursing student who has demonstrated competencies in these skills.
An alarm caused by a loose cardiac monitor lead startles a client with chest pain. What nursing intervention is best to perform next? A) Identify the client's current heart rhythm. B) Explain the reason the alarm sounded. C) Give the client a prescribed tranquilizer. D) Provide the client with a magazine to read.
Answer: B The nurse performs the role of educator by providing explanations to a client who is unfamiliar with hospital equipment. Explanations are best in simple, understandable terms. Once informed, the client has a basis for interpreting and coping with what are unique experiences. The client is unlikely to understand what the name of a heart rhythm implies. Administering a tranquilizer or distracting the client with a magazine does not help to prevent a similar fearful response if the situation recurs.
A client with chronic hyperparathyroidism expresses that she is fed up with her diet and can no longer continue with it. What should the nurse's appropriate response to the client be? A) "What is the reason that you cannot adhere to the prescribed diet?" B) "You may be having a difficult time staying on the diet; lets discuss it." C) "I think it is not so difficult to follow the suggested dietary restrictions." D) "It's important to stay on the diet to prevent formation of kidney stones."
Answer: B The nurse should reflect her understanding of the client's condition and encourage her to verbalize her concerns. The open statement by the nurse is an invitation to length discussion on the topic. In contrast, the first response may block further communication. Also, the third response asks the client about reasons that client may not reveal. Finally, the fourth response devalues the client and is not appropriate.
When a terminally ill client does not respond to medical treatment, which nursing action is most helpful in assisting the client to deal with his or her impending death? A) Providing literature on death and dying. B) Allowing the client privacy to think alone. C) Listening to the client talk about his or her feelings. D) Encouraging the client to get a second opinion.
Answer: C The best therapeutic nursing action is to facilitate the client's discussion of his or her feelings. Reading literature on an emotional topic and thinking privately may help some people, but they are not as effective as verbalizing thoughts for most people. If the client requests a second opinion, the nurse should pursue it; however, it is inappropriate for the nurse to initiate the suggestion. Doing so is considered false reassurance because it implies that the nurse believes the present medical regimen is less than optimal and that other alternatives can change the outcome
The wife of a client who is terminally ill expresses to the nurse that she is unable to see her husband die and she may not come to the health care facility anymore. What should the nurse's response to her be? A) "I think at this stage of the disease, you should focus on your husband and not yourself." B) "Your husband would come to know that you are not here, and you would feel guilty." C) "You are right; after all, your husband knows that you love him. We will take care of him." D) "You have been coming here every day; are you taking some time for yourself?"
Answer: D The first response indicates empathy and the nurse's understanding of the emotional pain that the wife is experiencing. The nurse should suggest to the spouse to take time out for herself. The second response indicates a judgmental attitude and blames the wife. The third option is nontherapeutic, as the nurse comments about an area she is not aware of. The fourth option indicates dependency, which is nontherapeutic.
A nurse anticipates collaborating with the UAP, physical therapist, surgeon, and respiratory therapist in which circumstance? A) Preparing a client to receive treatment for second degree burns. B) Feeding the client who has difficulty swallowing after a stroke. C) Ambulating a client with a new leg cast and crutches. D) Caring for a client following a total hip replacement.
Answer: D The nurse acts as a collaborator and is responsible for managing client care and delegating care to others, such as an unlicensed assistive personal (UAP). Collaboration also occurs with other members of the healthcare team, such as the physician. In this case, the client would benefit from physical therapy and respiratory therapy following surgery. The client preparing to receive treatment for a second degree burn, the client who has trouble swallowing, and the ambulating client with a new cast would not benefit as much from the collaboration with the nurse, UAP, physical therapist, surgeon, and respiratory therapist.
A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "if my doctor did a good job, I would not be here right now!" What is the nurse's best response? A) Stand and say, "I can see this interview is making you uncomfortable, so we can continue later." B) Nod and say, "I agree. If I were you, I would get a new doctor." C) Smile and say, "Don't worry, I am sure the physician is doing a good job." D) Be silent and allow the client to continue speaking when ready.
Answer: D 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.
A nurse is working on a medical surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which information will the nurse consider when deciding what nursing actions to delegate to the LPN/LVN? (Select all that apply.) A) Scope of practice B) Hospital policy C) LPN/LVN teaching ability D) LPN/LVN proficiency level E) Client stability
Answers: A, B, D, and E As nurses perform the role of delegators, they must know which tasks are legal and appropriate for particular healthcare providers to perform, or the scope of practice. They must also know the policy for the facility at which they are employed. Nurses must ensure that the person they are delegating the task to has the expertise and knowledge to perform it correctly, that the client is stable, and the task does not require the expertise of the registered nurse to perform. Teaching is not in the current scope of practice for a LPN/LVN
A nurse is performing an admission assessment with a non-English speaking client. Which actions can the nurse take to enhance communication? (Select all that apply.) A) Use gestures and pictures to convey information. B) Ask the client's teenage daughter to interpret. C) Request assistance from an agency interpreter. D) Use an electronic translator. E) Contact a telephone-based medical interpreter.
Answers: C, D, and E Some options for non-English speaking clients include requesting assistance from a trained agency interpreter. If they are not available, using a trained telephone interpreter or an electronic translator may assist in obtaining information. Using family members is not appropriate, since it is a violation of client HIPPA rights. In addition, clients may not feel comfortable explaining all of their symptoms using a family member, and medical terminology may not be translated correctly.