Chapter 20: Communication
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 neurolgoical checks every 2 hours and the nurse should report any alterations to the health care provider. In which section should this information be relayed? A) Recommendation B) Background C) Situation D) Assessment
A)Recommendation
A nurse in the rehabilitation division states to her head nurse, Mr. Tyler, "I need the day off and you didn't give it to me!" The head nurse replies, "Well I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate". Instead of this exchange, what communication by the nurse would have been more effective? A) Mr. Tyler, I placed request to have August 8th off, but I'm working and I have a doctor's appointment B) Mr. Tyler, I would like to discuss my schedule with you. I requested the 8th of august off for a doctor's appointment. Could I make an appointment? C) Mr. Tyler, I will need to call in on the 8th of August because I have a doctor's appointment D) Mr. Tyler, since you didn't give me the the 8th of August off, will I need to find someone else to work for me?
B) Mr. Tyler, I would like to discuss my schedule with you. I requested the 8th of august off for a doctor's appointment. Could I make an appointment?
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: A) "Are you allergic to any medications?" B) "Can you tell me the medications you take on a daily basis?" C) "Do you have and advanced directive or a living will?" D) "Can you tell me why your physician sent you here to be admitted?"
D) "Can you tell me why your physician sent you here to be admitted?"
A 3-year old child is being admitted to a medical division for vomiting, diarrhea, and dehydration. During the administration interview, the nurse should implement which communication techniques to elicit the most information from the parents? A) The use of reflective questions B) The use of closed questions C) The use of assertive questions D) The use of clarifying questions
D) The use of clarifying questions
small-group communication
2+ people
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship? A) working phase B)termination phase C)evaluation phase D) orientation phase
A) working phase
A client is reluctant to undergo surgery and is discussing it with the nurse. Which response by the nurse would reflect an authoritarian approach? A) "If you don't have the surgery you may not live. Your family needs you." B) "Surgery is your only option. You need this operation. C) "It's your choice about the surgery. What do you understand about the situation?" D) "Your grandchildren would be very upset if they lost their grandfather."
B) "Surgery is your only option. You need this operation.
Semantics
Meaning of words
Type of question? is used to place events in chronologic order to investigate a cause and effect relationship
Sequencing question
3 phases of helping relationship: -nurse and client accept feelings of loss - client accepts that this is the end of the relationship
Termination phase
intrapersonal communication
self-talk/communication with oneself
What is nonverbal communication?
body language, gestures, expressions
Type of question? allows the nurse to gain an understanding of a patient's comment; used to prevent possible misconceptions
clarifying question
Type of 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 question
is the process of exchanging information and generating and transmitting meanings between 2 or more people
communication
interpersonal communication
communication between 2 people
receiver (decoder) does what?
interprets the message sent and received
3 phases of helping relationship: -opens the relationship - clarify the problem
introductory phase
actual communication product from the source
message
Type of question? allows the patient a wide variety of responses; when obtaining nursing history
open-ended questions
Type of question? technique involves repeating what the person has said or describing the person's feelings
reflective question
incivility
rude, intimidating, and undesirable behavior directed at another person
What is verbal communication?
the use of language or words spoken
Type of question? serves to validate what the nurse believes he or she has heard/observed
validating question
A nursing student is nervous and concerned about the work she is about to do at the clinical facility. To allay anxiety and be successful in her provision of care, it is most important for her to: A) Determine the established goals of institution B) Be sure her verbal and nonverbal communication is congruent C) Engage in self-talk to plan her day and decrease her fear D) Speak with her fellow colleagues about how they feel
C) Engage in self-talk to plan her day and decrease her fear
A graduate nurse has been working on a telemetry unit for 6 months. The nurse arrives at work in the morning and overhears a night shift nurse talking about the graduate nurse. The night shift nurse is heard saying, "That new nurse is only here to meet a doctor and get married." The best response by the new nurse would be to: A) approach the night shift nurse and tell her that she is "out of line". B) call hospital security and ask them to take a report. C) ask to speak to the night shift nurse in private and explain how the comment made you feel D) ignore the comment and begin her shift
C) ask to speak to the night shift nurse in private and explain how the comment made you feel
Rapport
experience of mutual trust
anger and aggressive behavior between nurses or nurse-to-nurse hostility
horizontal violence "bullying"
3 phases of helping relationship: -explore thoughts and feelings -facilitating and taking action
working phase
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: A) staring into the neonate's eyes and smiling. B) softly humming a song near the neonate. C) offering the neonate infant formula. D) swaddling the child and gently stroking its head.
D) swaddling the child and gently stroking its head.
sender/the source(encoder) does?
initiates the communication process/conversation
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? A) "I understand you have four kids; how many times have you actually been pregnant?" B) "All right, you have four children, is that correct?" C) "How old are your children?" D) "Were these term births?"
A) "I understand you have four kids; how many times have you actually been pregnant?"
A nurse has developed strong rapport with the wife of a client who has been receiving rehabilitation following a debilitating stroke. The wife has just been informed that her husband will be unlikely to return home and will require care that can only be provided in a facility with constant nursing care. The client's wife tells the nurse, "I can't believe it's come to this." How should the nurse best respond? A) "This must be very difficult for you to hear. How do you feel right now?" B) "Why do you think that the care team has made this recommendation?" C) "Do you understand that everyone here has your husband's best interest at heart?" D) "What would help you accept that this is best for both of you?"
A) "This must be very difficult for you to hear. How do you feel right now?"
A nurse is providing instruction to a patient regarding the procedure to change his colostomy bag. During the teaching session, he asks, "What type of foods should I avoid to prevent gas?" The patient's question allows for what type of communication? A) A close-ended question B) Information clarification C) The nurse to give advice D) Assertive behavior
B) Information clarification
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic? A) "You should try laser surgery." B) "Why don't you try laser surgery?" C) "My grandfather also benefited from laser surgery." D) "Have you ever thought of laser surgery?"
D) "Have you ever thought of laser surgery?"
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. What is an example of the proper use of social media by a nurse? A) A nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's. B) A nurse describes a client on Twitter by giving the room number rather than the name of the client. C) A nurse posts pictures of a client who accomplished a goal of losing 100 pounds and later deletes the photo. D) A nurse describes a client on Twitter by giving the client's diagnosis rather than the client's name.
A) A nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's.
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) Be silent and allow the client to continue speaking when ready. B) Smile and say, "Don't worry, I am sure the physician is doing a good job." C) Nod and say, "I agree. If I were you, I would get a new doctor." D) Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
A) Be silent and allow the client to continue speaking when ready.
When interacting with a patient, the nurse answers, "I am sure everything will be fine. You have nothing to worry about". This is an example of what type of inappropriate communication technique? A) Cliche B) Giving advice C) Being judgemental D) Changing the subject
A) Cliche
A nurse caring for a patient who is hospitalized following a double mastectomy is preparing a discharge plan for the patient. Which action should be the focus of this termination phase of helping the relationship? A) Determining the progress made in achieving established goals B) Clarifying when the patient should take medications C) Reporting the progress made in teaching to the staff D) Including all family members in the teaching session
A) Determining the progress made in achieving established goals
During a nursing staff meeting, the nurses resolve the problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply A) Group decision making B) Group leadership C) Group power D) Group identity E) Group patterns of interaction F) Group of cohesiveness
A) Group decision making D) Group identity E) Group patterns of interaction F) Group Cohesiveness
A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states, "How is she doing, since the baby's father is no help?" What is the nurse's best response to the neighbor? A) New mother's need support B) The lack of a father is difficult C) How are you today? D) It is a very sad situation
A) New mother's need support
A nurse sees a patient walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. It is important that the nurse assess the patient for: a. Pain b. Anxiety c. Depression d. Fluid volume deficit
A) Pain
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: A) have group members confront the dominant member to promote the needed team work. B) have group members issue a written warning to the dominant member. C) pick a team leader who is not the dominant member. D) plan a meeting where the dominant person cannot attend.
A) have group members confront the dominant member to promote the needed team work.
A nursing student is preparing to administer morning care to a patient. What is the most important question that the nursing student should ask the patient about personal hygiene? A) Would you prefer a bath or shower? B) May I help you with a bed bath now or later this morning? C) I will be giving you your bath. Do you use soap or shower gel? D) I prefer a shower in the evening. When would you like your bath?
B) May I help you with a bed bath now or later this morning?
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: A)ask the client's partner to leave the room to allow the client to focus B) eliminate as many distractions as possible C) ask the client if she is able to read D) ask all visitors to leave the room
B) eliminate as many distractions as possible
During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after she communicates the plan of care. What would be appropriate nurse responses in this situation? Select all that apply. A) Fill the silence with lighter conversation directed at the patient B) Use the time to perform the care that is needed uninterrupted C) Discuss the silence with the patient to ascertain its meaning D) Allow the patient time to think and explore inner thoughts E) Determine if the patient's culture requires pauses between conversation F) Arrange for a counselor to help with the patient cope with emotional issues
C) Discuss the silence with the patient to ascertain its meaning D) Allow the patient time to think and explore inner thoughts E) Determine if the patient's culture requires pauses between conversation
Paramedics arrive in the emergency department with a victim of a motor vehicle collision. The paramedic reports the driver was restrained, the car was traveling about 30 miles per hour (48 Km/hour) , and the air bags were not deployed. The paramedic continues to report the car was struck from behind and that all individuals in the car were able to self-extricate. Which statement made by the nurse is verifying the report from the paramedic? A) "Did a police officer take a report at the accident scene?" B) there any fatalities in the other vehicle?" C) "Was there any cracking of the windshield?" D) "All of the victims got themselves out of the car?"
D) "All of the victims got themselves out of the car?"
In which of the following situations would the SBAR technique of communication be most appropriate? A) A nurse is explaining the process of bone marrow biopsy to a client who is scheduled for the procedure. B) A nurse is teaching a client about the benefits of smoking cessation and the risks of continuing to smoke. C) A nurse is facilitating a family meeting in order to coordinate a client's discharge planning. D) A nurse is calling a physician to report a client's new onset of chest pain.
D) A nurse is calling a physician to report a client's new onset of chest pain.
A nurse enters a patient's room and examines the patient's IV fluids and cardiac monitor. The patient states "Well, I haven't seen you before. Who are you?" What is the nurse's best response? A) I'm just the IV therapist checking your IV bag B) I've been transferred to this division and will be caring for you C) I'm sorry, my name is John Smith and I am your nurse. D) My name is John Smith, I am your nurse and I'll be caring for you until 11 p.m.
D) My name is John Smith, I am your nurse and I'll be caring for you until 11 p.m.
A nurse enters the room of a patient with cancer. The patient is crying and states I feel so alone, Which statement is the most therapeutic? A) a nurse stands at the patient's bedside and states "I understand how you feel. My mother said the same thing when she was ill" B) The nurse places a hand on the patient's arm and states, "You feel so alone" C) The nurse stands in the patient's room and asks, "Why do you feel so alone? Your wife has been here everyday" D) The nurse holds the patient's hand and asks, "What makes you feel so alone?"
D) The nurse holds the patient's hand and asks, "What makes you feel so alone?"
A 76-year old patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the most appropriate comment or question to elicit additional information? A) Do you take two injections of insulin to decrease the complications? B) Most physicians recommend diet and exercise to regulate blood sugar C) Most complications of diabetes are related to neuropathy D) What specific complications have you experienced?
D) What specific complications have you experienced?
During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. When entering the room, what is the nurse's best response? A) you need to speak to the patient quietly. You are disturbing the patient B) Let me help you with your transfer technique C) When you are finished, be assure to apologize for your rough demeanor D) When your patient is safe and comfortable, meet me at the desk
D) When your patient is safe and comfortable, meet me at the desk
