Chapter 24 Communication
1, 2, 3 Using at least 14-point print makes it easy for the patient to see and read. Check whether the patient uses glasses to assess the degree of visual impairment and encourage the patient to use them. Use indirect lighting and avoid glare to reduce discomfort to the patient. Nurses should identify themselves and address the patient when entering the patient's room. The nurse should not rely on the patient's gestures and nonverbal communication.
The nurse is caring for a patient who is visually impaired. Which measures should the nurse take when communicating with this patient? Select all that apply. 1 Use at least 14-point print. 2 Check if the patient wears glasses. 3 Use indirect lighting and avoid glare. 4 Enter the room without addressing the patient. 5 Follow the patient's gestures and nonverbal communication
2, 4, 5 Drooped shoulders and slow walking indicate sadness, grief, depression, or illness. Blunt facial expression and avoidance of eye contact indicate indifference and unwillingness. Erect posture and brisk walking indicate well-being and confidence. Soft-toned speech indicates a welcoming attitude.
The nurse works in a long-term care facility and attends to a 52-year-old patient with type 2 diabetes mellitus. The patient is depressed and gets angry when people try to help. Which physical signs would the patient present that would lead the nurse to conclude that the patient is depressed and angry? Select all that apply. 1 The patient has an erect posture and walks briskly. 2 The patient has drooped shoulders and walks slowly. 3 The patient speaks in a very soft tone to people offering help. 4 The patient has a blunt facial expression when people offer her help. 5 The patient lacks eye contact while talking to any person willing to help.
2 Metacommunication includes all factors influencing communication, such as the tone of a verbal response and associated nonverbal behavior. An understanding of these factors helps the nurse to explore more details of a patient's history. Metacommunication does not refer to the communication skill used for individuals who are hearing impaired or for children.
What does metacommunication include? 1 Nonverbal communication skills 2 All factors influencing communication 3 Communication skills used for individuals who are hearing impaired 4 Communication skills used for children
1 Nurses may take patient feelings on as their own, which may hinder the nurse's ability to be objective and help the patient process their feelings. Focusing is a therapeutic communication technique that involves centering a conversation on key elements or concepts of a message. Clarifying is therapeutic communication technique to check whether you understand a message accurately by restating an unclear or ambiguous message to clarify the sender's meaning. Summarizing is a therapeutic communication technique that involves a succinct review of key aspects of an interaction.
Which is a nontherapeutic communication technique? 1 Sympathy 2 Focusing 3 Clarifying 4 Summarizing
2, 3, 4 Several actions promote active listening, including leaning towards the patient, sitting facing the patient with an open posture, and making eye contact. These help to communicate to the patient that the nurse is involved and interested in the conversation and is there to listen to concerns. Standing away with hands folded suggests disinterest. Restlessness and closing the eyes while listening expresses a lack of interest and discomfort.
A 35-year-old athlete becomes aggressive when not allowed to be ambulatory due to a fractured leg. The patient tries to get out of the bed unattended and falls. The nurse talks to the patient, who states, "I'm frustrated. I want to get out of here." The nurse encourages the patient to express concerns freely. Which techniques should the nurse utilize to actively listen to the patient? Select all that apply. 1 Stand away with hands folded. 2 Lean forward towards the patient. 3 Sit erect facing the patient with uncrossed arms. 4 Make eye contact. 5 Pace up and down the room. 6 Close eyes and listen.
3 When using SBAR (Situation-Background-Assessment-Recommendation) communication protocol, the nurse should first identify the patient's situation. In this case, that means the nurse should convey that the patient is suffering from chronic diabetes and hypertension. The nurse then should further address the situation and ask the dietitian to consider revising the diet. Following the dietary assessment and consult, the recommendations for dietary changes—including low-salt and low-sugar meals—should be made.
A 40-year-old patient is suffering from poorly controlled hypertension. The dietitian recommends several dietary modifications to the patient. The patient tries to explain the reason for the poor dietary compliance; the patient works extra hours and does not have the time to cook. The patient also has diabetes and expresses that it is difficult to choose a diet that is low in sugar as well as low in salt and carbohydrates. The nurse communicates this to the dietitian using SBAR (Situation-Background-Assessment-Recommendation) technique. Which should be addressed first? 1 The patient has chronic diabetes with hypertension. 2 The patient needs a diet revision. 3 The patient wants a dietary consult. 4 The patient should be persuaded to eat low-salt, low-sugar meals
1, 5 Documenting the nursing diagnostic procedure is included under the nursing diagnosis phase of communicating throughout the nursing process. Verbally communicating or discussing with the health care team is included under the implementation phase. Verbally interviewing and asking for history is an effective form of communication. Visually observing the nonverbal behavior of others and gathering data during physical examination are also included in effective communication.
A registered nurse (RN) is teaching a nursing student about the different assessments required while communicating throughout the nursing process. Which statement by the nursing student indicates the need for further teaching? Select all that apply. 1 "I will document the diagnostic procedure." 2 "I will verbally interview and ask for history." 3 "I will visually observe for nonverbal behavior." 4 "I will gather data during physical examination." 5 "I will verbally communicate with the health care team."
1 Intrapersonal communication is a form of communication that occurs within an individual. This can also be referred to as self-talk or self-verbalization. Interpersonal communication occurs on a one-on-one basis between the nurse and the patient. Transpersonal refers to communication that occurs within the spiritual domain, and small-group communication occurs in a group.
The nurse explains to a patient that self-talk can improve self-awareness and help build a positive self-concept. To which level of communication does this refer? 1 Intrapersonal 2 Interpersonal 3 Transpersonal 4 Small-group communication
4 Interpersonal communication is an interaction that occurs within the spiritual domain of the patient. Therefore, the nurse assesses the spiritual and cultural needs of the patient using the transpersonal level of communication. The nurse uses small-group communication while communicating with a small number of persons with a common goal. Intrapersonal communication occurs within an individual and helps express perceptions, feelings, and self-concept. Therefore, intrapersonal communication is not involved in the cultural assessment of the patient. The nurse uses public communication while at conferences with colleagues or during classroom discussions with peers or students, not when performing a cultural assessment.
The nurse finds that a patient avoids taking painkillers due to a fear of drug addiction, in accordance with the patient's cultural beliefs. Which level of communication should the nurse use for cultural assessment of the patient? 1 Public 2 Small group 3 Intrapersonal 4 Interpersonal
3 SBAR is an acronym for Situation, Background, Assessment, and Recommendation, which is used as a communication technique. The patient nurse informs the primary health care provider about the patient's history of congestive heart failure when communicating the patient's background information. Blood pressure findings are included when communicating assessment information. The complaint of perspiration and chest pain is included when communicating the patient's situation. Requesting an order from PHCP to treat the patient represents a recommendation.
A patient is admitted to the hospital with congestive heart failure. The nurse immediately notifies the primary health care provider using the SBAR (Situation, Background, Assessment, and Recommendation) technique. Which statement by the nurse demonstrates "background"? 1 "The blood pressure of the patient is 150/90 mm Hg." 2 "The patient has severe perspiration and chest pain." 3 "The patient has a history of congestive heart failure." 4 "The nurse requests an order from the primary health care provider to treat the patient."
1 It is very important for the nurse to clarify an ambiguous statement like "I am feeling sicker than yesterday." To check for accurate understanding, the nurse should restate the message to clarify the meaning. The nurse should also ask the patient for more information or give an example of what the patient means before calling the emergency staff, contacting the supervisor or nurse manager, or talking to a colleague.
A patient tells the nurse, "I am feeling sicker than yesterday." The nurse immediately calls the emergency staff to see the patient. What should the nurse have done before calling the rapid response team? 1 Clarify the patient's statement. 2 Contact the nurse supervisor. 3 Contact the nurse manager. 4 Take advice from a colleague.
3 The nurse should not give false reassurances or tell the patient she will be fine when a patient is seriously ill or distressed. This may block the conversation once the patient reaches an understanding and may do more harm than good. Therefore, it is important to give the facts and assure the patient that healthcare providers are there to help. Information about the patient is confidential and should not be given to any other person, including the husband, unless authorized by the patient. It is also incorrect to tell the patient that she has only a couple of months left without knowing the details of the problem.
A patient who is married and has a 3-year-old daughter is diagnosed with terminal cancer. The patient has come to see the nurse with her daughter and husband to talk about it. Which is the most appropriate response by the nurse? 1 Talk to the patient's husband first. 2 Convince the patient that she will be fine. 3 Inform the patient about palliative care options. 4 Tell the patient that she only has a couple of months left to live.
2 The patient with posttraumatic stress disorder will have persistent mental and emotional stress and may not be able to set goals and make decisions properly. In this context, the nurse encourages and helps the patient set goals during the working phase of the helping relationship. Assessing the status of health in the patient occurs during the orientation phase. The orientation phase includes making inferences about patient messages and behaviors. The nurse anticipates health concerns or issues during the preinteraction phase.
A patient with posttraumatic stress disorder is admitted into a psychiatric unit. Which action performed by the nurse indicates the working phase of the helping relationship? 1 Assessing the patient's health status 2 Encouraging and helping the patient set goals 3 Making inferences about patient messages and behaviors 4 Anticipating the health concerns or issues that has aroused
2, 3, 4 Verbal communication with patients requires appropriate intonation, because tone makes the intention of the sentence clear and encourages effective communication. Properly paced statements help the patient to clearly understand what is communicated, keeping in view the age and health condition of the patient. Verbal communication with patients requires clear and concise phrasing to communicate clearly and focus on the most important aspect. Closed questions do not promote communication and may not yield enough information. Open-ended questions promote communication, and the patient tenders more information. Hurried complex statements can confuse the patient.
The nurse is asking a patient about pain in the abdomen. Which should the nurse use as an appropriate means for effective communication? Select all that apply. 1 Closed questions 2 Appropriate intonation 3 Properly paced statements 4 Clear and concise phrasing 5 Hurried complex statements
2, 3, 5 Confrontation should be used only after establishing trust and should be used with sensitivity so that the patient does not feel offended. Confrontation improves patient self-awareness and helps the patient to recognize growth and deal with important issues. By confronting patients in a therapeutic way the nurse helps them to become more aware of inconsistencies in their feelings, attitudes, beliefs, and behaviors. Paraphrasing is restating a patient's message in order to clarify meaning. The technique of focusing deals with focusing on an important message in a vague discussion.
The nurse is asking a patient about symptoms. Which factors should the nurse consider when using the method of confrontation as a therapeutic means of communication with the patient? Select all that apply. 1 Confrontation is restating the patient's message using the patient's own words. 2 Confronting patients should be done gently and after establishing trust. 3 Confronting patients improves patient self-awareness in a therapeutic way. 4 Confrontation helps nurses to focus on an important message in a vague discussion. 5 Using confrontation helps the patient to become aware of inconsistent feelings.
1 Clarifying refers to seeking more information from the patient for better understanding. Focusing is used when a patient is rambling and is a technique that helps to focus the conversation on a specific area. Paraphrasing is rephrasing a patient's sentence in one's own language without changing the meaning. Self-disclosure is the term used when a person intentionally reveals personal experiences to another person.
The nurse is assessing the psychosocial well-being of a patient who says that there is no meaning to life, and the patient wants to see the end of it. The nurse asks the patient, "Are you talking about suicide?" What is this communication technique called? 1 Clarifying 2 Focusing 3 Paraphrasing 4 Self-disclosure
1, 3, 4 When the nurse is caring for a visually impaired patient, it is effective to use indirect lighting and to avoid glare. It is recommended to use at least 14-point type when providing reading material to a visually impaired patient. Do not rely on gestures or nonverbal communication while communicating with visually impaired patients. Make sure that the patient is using glasses or contact lenses. The nurse should communicate in a normal tone of voice.
The nurse is caring for a 65-year-old patient who is visually impaired. Which communication strategies by the nurse would demonstrate a lack of competence? Select all that apply. 1 Using direct light 2 Checking for use of glasses 3 Employing at least 9-point type 4 Using nonverbal communication 5 Articulating in a normal tone of voice
4, 5 While caring for a non-English speaking patient, a professional interpreter should be provided; a family member should not be used as an interpreter. Nodding or making statements such as "OK" are not necessarily indications of understanding. It is necessary to assess the patient's primary language and level of fluency in English. Incorporating the patient's communication methods or need into plan of care is an important action. Providing written information in English and in the primary language of the patient is an essential action while communicating with a non-English speaking patient.
The nurse is caring for a Spanish-speaking patient with a hand fracture. Which approaches are likely to be ineffective when communicating with the patient? Select all that apply. 1 Assessing the patient's level of fluency in English 2 Incorporating the patient's communication methods 3 Providing written information in English and the primary language 4 Designating a family member of the patient as an interpreter 5 Perceiving patient nodding or statements such as "OK" as indications of effective understanding
1, 3, 4 Anxiety may arise due to the inability to communicate effectively. Difficulty in self-expression can lead to alteration in social interaction and social isolation. Altered communication and difficulty in self-expression can lead to ineffective coping. Stomach pain could be an existing condition with an underlying cause, but it is not caused by an impaired ability to communicate verbally. Difficulty in movement can be present as an associated problem but is not caused by an impaired ability to communicate verbally.
The nurse is caring for a patient who is unable to communicate properly due to laryngeal cancer. Which could be the consequences of diminished ability to speak in this patient? Select all that apply. 1 Anxiety 2 Stomach pain 3 Social isolation 4 Ineffective coping 5 Difficulty in movement
1, 3, 4 Asking simple questions that require "yes" or "no" answers makes comprehension and answering easier for the patient. Using communication aids eases the process and makes the patient feel comfortable. Listening attentively and patiently makes the patient feel comfortable. Visual clues can be used as required to ease the process of communication. The nurse should avoid assuming the patient's answers; rather, let the patient know if something is not understood, because this will encourage effective communication.
The nurse is caring for a patient with aphasia. Which precautions should the nurse take when communicating with this patient? Select all that apply. 1 Ask simple questions. 2 Avoid using visual clues. 3 Use communication aids. 4 Listen attentively and patiently. 5 Assume the patient's answers without disturbing.
1 Sharing hope is the therapeutic technique that involves the nurse recognizing the patient's condition and giving encouragement and positive feedback while fostering self-confidence, which is essential for healing. Sharing feelings involves helping patients share emotions by encouraging openness and modeling healthy self-expression. Sharing empathy is the ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other individual. Sharing observations involves commenting on how the other person looks, sounds, or acts.
The nurse is caring for a patient with breast cancer and says, "You are a brave person and you will find a way to face this illness." Which type of therapeutic communication technique was involved in this interaction? 1 Sharing hope 2 Sharing feelings 3 Sharing empathy 4 Sharing observations
4 The termination phase is the final stage in the nurse-patient relationship. During this phase, the nurse reminds the patient that termination is near and also evaluates goal achievement. Advising the patient to change his or her lifestyle is involved in the working phase. Asking the patient about blood sugar levels and any foot ulcers is an aspect of checking the health status of the patient, which occurs during the orientation phase. Encouraging the patient to maintain a checklist of food habits and blood sugar levels would occur in the working phase.
The nurse is caring for a patient with diabetes. Which nursing action is involved in the termination phase of the nurse-patient relationship? 1 Advise the patient to change his or her lifestyle 2 Assess the patient for blood sugar level and for any foot ulcers 3 Encourage the patient to maintain a checklist of food habits and blood sugar level 4 Evaluate whether the patient has achieved the goal of maintaining normal blood sugar levels
3 The nurse should not assume that the patient is hard of hearing because she is 80, but it is more likely. The patient may have not responded because the nurse was across the room and water was running. The nurse should not jump to conclusions, but instead try again to communicate with patient as with someone who is hard of hearing.
The nurse is caring for an 80-year-old woman and asks the patient a question while the nurse is across the room washing hands. The patient does not answer. What is the nurse's next action? 1 Leave the room quietly, because the patient evidently does not want to be bothered right now. 2 Repeat the question in a loud voice, speaking very slowly. 3 Move to the patient's bedside, get her attention, and repeat the question while facing the patient. 4 Bring the patient a communication board so she can express her needs.
4 The nurse should use pictures or gestures to communicate with Patient D, who is cognitively impaired. Patient A has hearing impairment, so the nurse should speak facing the patient with the mouth visible and arrange for a sign language interpreter if indicated. Patient B has a visual impairment, so the nurse should avoid relying on gestures or nonverbal communication. Patient C has a speaking disability, so the nurse should use visual cues to communicate.
The nurse is caring for different patients with disabilities. Which patient would benefit from the use of a picture or gestures that mimic the desired action? 1 Patient A 2 Patient B 3 Patient C 4 Patient D
2 When changing a patient's surgical dressing, the nurse enters the intimate zone of personal space. Speaking at a community forum involves the public zone. When sitting at a patient's bedside and taking a patient's history, the nurse is in the personal zone. When giving a verbal report to a group of nurses, the nurse is in the socio-consultative zone.
The nurse is changing a patient's surgical dressing. Which zone of personal space is the nurse entering? 1 Public zone 2 Intimate zone 3 Personal zone 4 Socio-consultative zone
2 Autonomy refers to the state of being self-directed and independent in accomplishing goals and advocating for others. Empathy is the ability to understand a person's reality. Saying hello or goodbye to a patient or knocking on the door before entering a patient's room are gestures of courtesy. Assertiveness is the ability to express opinions without being judgmental.
The nurse is explaining the elements of professional communication to nursing students. The nurse states that being self-directed and independent is essential for accomplishing goals. Which element of communication is the nurse describing? 1 Empathy 2 Autonomy 3 Courtesy 4 Assertiveness
2 When a patient is communicating through prayer, mediation or other means with a higher power or deceased loved one, transpersonal communication is taking place. Intrapersonal communication happens within the person. Nonpersonal is not a type of communication. Small-group communication is a goal-directed type of communication that occurs when a small number of persons meet.
The nurse is exploring an elderly patient's spiritual needs, which include meditation. Which term describes the type of communication involved when meditating? 1 Small-group 2 Transpersonal 3 Intrapersonal 4 Nonpersonal
1, 2, 4 The four zones of touch include the social, consent, vulnerable, and intimate zones. The arms, back, and shoulders come under the social zone, for which permission is not needed. When the nurse needs to touch a person in the consent zone, it is better to ask for permission from the patient first. The wrist and feet come under the consent zone.
The nurse is having a conversation with a patient. Which actions by the nurse would not require permission from the patient? Select all that apply. 1 Touching the patient's arms 2 Patting the patient's back 3 Holding the patient's wrist 4 Patting the patient's shoulders 5 Touching the patient's feet
2 Situational context involves the reason for communication, which is problem resolution in this instance. Relational context indicates the nature of the relationship among participants, such as a social, helping, or working relationship. Environmental context involves the physical surroundings in which communication occurs. The psychophysiological context involves internal factors affecting communication, such as physiological status and emotional status.
The nurse manager calls a meeting of members of the nursing team to resolve problems surrounding patient complaints of slow and sometimes discourteous responses to requests. What role does problem resolution play in this communication? 1 Relational context 2 Situational context 3 Environmental context 4 Psychophysiological context
4 The nurse manager is providing a verbal report to a group of team members. Which zone of personal space is indicated in the nurse's action? 1 Public zone 2 Intimate zone 3 Personal zone 4 Socio-consultative zone
The nurse manager is providing a verbal report to a group of team members. Which zone of personal space is indicated in the nurse's action? 1 Public zone 2 Intimate zone 3 Personal zone 4 Socio-consultative zone
1 Metacommunication is a broad term that refers to all factors that influence communication. It involves being aware of influencing factors and helping people understand better what is communicated. Therefore, by acknowledging the patient's nonverbal signs of stress and understanding the situation better, the nurse employs metacommunication. Nonverbal communication involves the five senses and anything that does not involve the spoken or written word; the patient's facial expression is an example of nonverbal communication. Nurses use intrapersonal communication to develop self-awareness and a positive self-esteem that enhances appropriate self-expression. Nontherapeutic communication involves asking personal questions or giving personal opinions, which discourages further expression of patient's feelings and ideas.
The nurse notices tension on the face of a patient before going to the operating room. The patient says, "I don't mind going in for surgery." The nurse acknowledges the patient's nonverbal indications of stress and prompts the patient to elaborate on his or her feelings. Which type of communication is the nurse exhibiting? 1 Metacommunication 2 Nonverbal communication 3 Intrapersonal communication 4 Nontherapeutic communication
1, 3, 4 Pacing is the appropriate rate at which speech is delivered and is important for effective verbal communication. Intonation is the use of tone that indicates the expression and the emotions of the speaker. Vocabulary is the use of words; the ability to understand words forms an important part of verbal communication. Posture is maintaining and moving the body and is part of nonverbal communication. Facial expression is the emotion conveyed by the movement of facial structures and is also part of nonverbal communication.
The nurse understands that effective verbal communication is important in nursing practice. Which aspects of verbal communication improve effectiveness? Select all that apply. 1 Pacing 2 Posture 3 Intonation 4 Vocabulary 5 Facial expression
1, 2, 3 Speaking clearly and slowly gives the patient time to comprehend what the nurse is saying. Patients who have hearing aids are encouraged to use them to improve communication. When patients are aware that the nurse is talking, they are more attentive and try to comprehend better. Speaking quickly will not encourage effective communication; rather, speaking slowly and being patient will help. The nurse should face the patient and make sure that the patient can see the nurse's mouth when speaking.
The nurse works in a nursing home and understands that most of the elderly patients have varying degrees of hearing loss. Which interventions would help the nurse to communicate with these patients? Select all that apply. 1 Speak clearly and slowly. 2 Check for the patient's hearing aids. 3 Make the patient aware while talking. 4 Speak quickly and move to the next task. 5 Avoid facing the patient while speaking.
2 Stating that the patient is a fighter and will find a way to face the condition is an example of the therapeutic communication technique of sharing hope. Stating that the patient seems cheerful indicates the therapeutic communication technique of sharing observations. Stating that the patient might be irritated by being bedridden for a month due to a leg fracture indicates the therapeutic communication technique of sharing empathy. Instructing the patient to walk for five minutes, as suggested by the primary health care provider, indicates the therapeutic communication technique of sharing observations.
The registered nurse (RN) is communicating with a patient in the surgical unit. Which statement by the RN indicates the technique of sharing hope? 1 "You seem to be cheerful today." 2 "You are a fighter and I know you can find a way to face this condition." 3 "I understand that you may be frustrated that you are bedridden for a month." 4 "You have to walk for five minutes, as directed by the primary health care provider."
5, 1, 2, 3, 4 AIDET is a technique that is commonly used in hospitals today, and stands for Acknowledge, Introduce, Duration, Explain, and Thank you. The nurse first acknowledges the patient standing in front of him or her with a positive attitude and makes the patient feel comfortable. The nurse then introduces himself or herself, and lets the patient know what his or her role is in the department. In the third step the nurse should provide details to the patient or the family members about the duration of the procedure. This keeps the patient informed of any delays that may occur. Then explain how the procedure or test takes place and describe typical the patient experience with the procedure. The last step is to thank the patient for coming to the organization for care and let the patient know how much he or she enjoyed working with the patient.
The registered nurse (RN) is planning to follow AIDET technique to provide accurate and timely communication, and to deliver excellent patient service. In what order is AIDET followed? 1. Notify the patient about the role of the nurse. 2. Tell the patient how long the test procedure is. 3. Describe the test to be performed to the patient. 4. Express gratitude to the patient for coming to the organization. 5. Convey a positive attitude and help the patient feel comfortable.
2 Assertive behavior can help nurses deal with criticism and manipulation by others and learn to say no, set limits, and resist intentionally imposed guilt. Assertive behavior will not necessarily help nurses avoid ethical dilemmas; on the contrary, ethical dilemmas may arise that make assertiveness difficult to implement for fear of retaliation. Fostering trust through conveying warmth, honesty, consistency, and competence helps the nurse move beyond superficial care. Effective assertive behavior can help reduce the incidence of lateral violence in the workplace.
The registered nurse (RN) is teaching a nursing student about assertive behavior when interacting with patients and coworkers. Which statement by the nursing student indicates effective learning? 1 "It helps the nurse avert ethical dilemmas." 2 "It helps to resist intentionally imposed guilt." 3 "It helps the nurse move beyond superficial care." 4 "It may result in an environment conducive to lateral violence."
1, 5 When communicating with the patient who has hearing impairment, the nurse should communicate at normal volume rather than shouting. The nurse should rephrase rather than simply repeat statements if the patient misunderstands. While speaking to the patient, the nurse face the patient with his or her mouth visible to facilitate lip reading. The nurse should reduce the environmental noise so the patient can hear properly without any disturbance. The nurse should check for the patient's hearing aids and glasses before communicating.
The registered nurse (RN) is teaching a nursing student about communicating with a patient who has a hearing impairment. Which statements made by the nursing student indicate the need for further learning? Select all that apply. 1 "I should speak at an elevated volume." 2 "I should reduce environmental noise." 3 "I should face the patient with my mouth visible." 4 "I should check the patient for hearing aids and glasses." 5 "I should repeat rather than rephrase if there is any misunderstanding."
1, 3, 4 While counseling a patient, the nurse should be in the personal zone of 18 in (46 cm) to 4 ft (122 cm). While speaking at a community forum, the public zone of 12 ft (366 cm) or more is generally maintained. The special zones of touch in which the nurse should ask for permission include the wrist or feet. While taking patient history, the nurse should be in the personal zone of 18 in (46 cm) to 4 ft (122 cm). While performing physical assessment, the nurse would enter the intimate zone of 0-8 in (0-20 cm).
The registered nurse (RN) is teaching a nursing student about the personal zones of space while communicating with patients. Which statements by the nursing student indicate effective learning? Select all that apply. 1 "I should be in the personal zone while counseling the patient." 2 "I should maintain a distance of 9 ft (274 cm) while taking patient history." 3 "Speaking at a community forum generally involves the public zone." 4 "I should ask for permission before assessing the patient's wrist or feet." 5 "I should be in the socio-consultative zone while performing physical assessment."
1, 2, 4 Summarizing provides a short review of the key areas of interaction, which helps in recalling previous discussions and makes further discussions easier. Summarizing helps the participants to focus on key issues, offers a chance for revision, and makes the interaction more productive. It is also useful in the terminal phases of the patient relationship to sum up the discussion. Using this technique, any points that are misunderstood can be clarified. Revealing true personal experiences is part of self-disclosure. Using touch, not summarizing, brings a sense of caring and human connection.
The senior nurse is teaching a group of nursing students about using the technique of summarizing in therapeutic communication. Which are advantages of summarizing? Select all that apply. 1 It helps recall previous discussions. 2 It helps participants to focus on key issues. 3 It helps reveal true personal experiences. 4 It is useful in the terminal phases of the patient relationship. 5 It brings a sense of caring and human connection.
1, 2, 5 Passive responses serve to avoid conflict or sidestep issues. They reflect feelings of sadness, depression, anxiety, powerlessness, helplessness, and hopelessness. Aggressive responses may indicate anger, frustration, and stress, and may provoke others. Assertive responses are a more professional approach, because the nurse needs to remain calm but face the problem with assertive communication.
The senior nurse is training a nursing student about the professional approach in communication. The nurse explains that the way one responds to a question or a situation indicates state of mind. Which statements are true about this explanation? Select all that apply. 1 Passive responses serve to avoid conflict or sidestep issues. 2 Aggressive responses provoke confrontation. 3 Passive responses reflect anger and frustration. 4 Aggressive responses help to avoid issues. 5 Assertive responses are a more professional approach.
3 The personal zone is 18 inches to 4 feet. This distance allows for easy communication without invading the person's personal space.
When the nurse takes the patient's nursing history, where is the most therapeutic place for the nurse to sit? 1 Next to the patient 2 4 to 12 feet from the patient 3 18 inches to 4 feet from the patient 4 12 inches to 3 feet from the patient
1 The nurse maintains varying distances while carrying out different activities. The zone of personal space is 18 inches to 4 feet. The nurse maintains a personal zone while teaching a patient and taking a patient's nursing history. The nurse maintains a social zone, or a distance of 4 to 12 feet, while making rounds with a physician. The nurse enters the intimate zone, a distance of 0 to 18 inches from the patient, when performing physical assessment or when exchanging patient information at the nurses' station in order to protect the patient's privacy in a public area.
Which activity does the nurse carry out while maintaining a zone of personal space? 1 Teaching or educating a patient 2 Making rounds with a physician 3 Performing a physical assessment 4 Exchanging patient information at nurses' station
4 Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face-to-face. This interaction is useful to assess understanding and clarify misinterpretations when teaching a patient about a health concern. Public communication is interaction with an audience. Nurses often speak with groups of consumers about health-related topics. Small group communication occurs when a small number of people meet. This type of communication is usually goal directed and requires an understanding of group dynamics. Intrapersonal communication is a powerful form of communication that you use as a professional nurse. This level of communication is also called self-talk.
Which form of communication is appropriate to assess understanding and clarify misinterpretations when the nurse is teaching a patient about a health concern? 1 Public communication 2 Small-group communication 3 Intrapersonal communication 4 Interpersonal communication
2, 3, 4 There are four phases of therapeutic relationship building in clinical nursing practice. The working phase starts when the nurse and patient work together to solve problems and accomplish goals. In this phase, the nurse provides encouragement and helps the patient set goals that are achievable. The nurse initiates action and encourages the patient to implement those actions. The working phase helps the nurse to meet the goals set with the patient. The nurse also provides information that the patient needs to understand to change behavior in order to achieve optimal health. The nurse should assess the patient's health status in the orientation phase, which helps the nurse to understand the patient's needs and requirements. The nurse discusses the patient with other caregivers before meeting the patient in the preinteraction phase, not in the working phase.
Which nursing interventions help the nurse establish a therapeutic relationship while working with a patient to solve problems and accomplish goals? Select all that apply. 1 Assessing the patient's health status 2 Encouraging and helping the patient set goals 3 Taking action to meet the goals set with the patient 4 Providing information needed to understand and change behavior 5 Talking to other caregivers who have information about the patient
2 In the consent zone, the nurse needs permission to touch patient`s mouth, wrists, and feet. In the social zone, the nurse does not need permission to touch the patient's hands, arms, or shoulders. In the intimate zone, great sensitivity is needed in the areas of genitalia and rectum. In the vulnerable zone, the nurse takes special care to handle the patient`s face, neck, and front of body.
Which special zone of touch requires the nurse to get permission to touch patient`s wrist? 1 Social zone 2 Consent zone 3 Intimate zone 4 Vulnerable zone
4 Collaboration involves everyone working together to best meet the needs of the patient. A care plan that incorporates the expertise of professionals from varied disciplines best addresses patient needs.
Which statement best explains the role of collaboration with others for the patient's plan of care? 1 The professional nurse consults the health care provider for direction in establishing goals for patients. 2 The professional nurse depends on the latest literature to complete an excellent plan of care for patients. 3 The professional nurse works independently to plan and deliver care and does not depend on other staff for assistance. 4 The professional nurse works with colleagues and the patient's family to provide combined expertise in planning care.
1 Commenting on the positive aspects of a patient's behavior and response develops hope in the patient. Sharing feelings involves helping patients share emotions by encouraging openness and modeling healthy self-expression. Sharing empathy is the ability to understand the patient's reality, perceive feelings accurately, and communicate this understanding to the patient. Sharing observations involves commenting on observations such as the looks, sounds, or actions of the patient.
While interacting with a patient, the nurse comments on positive aspects of the patient's behavior and response. Which therapeutic communication technique does the nurse exhibit? 1 Sharing hope 2 Sharing feelings 3 Sharing empathy 4 Sharing observations
3 Sitting and facing the patient and listening attentively conveys that the nurse is interested in what the patient is saying. When the nurse is leaning toward the patient and listening to the conversation, it conveys that the nurse is involved in the interaction. When the nurse is relaxed, it conveys that the nurse is comfortable with patient. When the nurse maintains eye contact with the patient, it conveys that the nurse is willing to listen to what the patient is saying.
While interacting with a patient, the nurse sits and faces the patient and listens attentively. What does this posture toward the patient convey? 1 The nurse is involved in the interaction. 2 The nurse is comfortable with the patient. 3 The nurse is interested in what the patient is saying. 4 The nurse is willing to listen to what the patient is saying.
3 Sympathy is the nontherapeutic communication technique exhibited by the nurse in this scenario. Sympathy is concern, sorrow, or pity felt for another person. Sharing humor is a therapeutic communication technique. Humor is an important, but often underused, resource in nursing interactions. Sharing feelings is a therapeutic communication technique. Sharing feelings can be a therapeutic communication technique; feelings are not right, wrong, good, or bad, although they may be pleasant or unpleasant. Giving personal opinions is a nontherapeutic communication technique in which the nurse injects his or her own views regarding care options; this may serve to take decision-making power away from patients.
While interacting with a woman who underwent a mastectomy, the nurse says, "I'm worried that you might feel devastated after your surgery." Which nontherapeutic communication technique does the nurse exhibit? 1 Sharing humor 2 Sharing feelings 3 Showing sympathy 4 Giving personal opinions
4 The nurse should use special communication skills when talking to hearing-impaired patients. When a patient does not understand any part of the conversation, the nurse should rephrase the sentence rather than restating it. Speaking in a normal volume facilitates better understanding. Other techniques to improve communication include reducing environmental noise and getting the attention of the patient before starting the interview.
While interviewing a patient with a hearing impairment, the nurse closes the door to reduce environmental noise and greets the patient to get the patient's attention. The nurse speaks in a normal volume and asks the patient to reduce carbohydrate intake. The patient does not understand what the nurse says, so the nurse restates what was said. Which part of the communication should the nurse avoid? 1 Speaking in a normal volume 2 Reducing the environmental noise 3 Gaining the patient's attention before the interview 4 Restating the sentence that the patient did not understand
4 Socializing is used during the orientation phase of a relationship to get acquainted and help establish trust.
The nurse is caring for a patient who is facing amputation of the leg. During the orientation phase of the relationship, what should the nurse do? 1 Summarize previous discussions. 2 Review the medical record and talk to other nurses about how the patient is reacting. 3 Explore the patient's feelings about losing the leg. 4 Talk with the patient about favorite hobbies.
3 While giving verbal report to a group of nurses, a socio-consultative zone of 9 to 12 feet (274 to 366 cm) is appropriate. While taking a patient's nursing history or teaching an individual patient, a personal zone of 18 inches (46 cm) to 4 feet (122 cm) is followed. While speaking at a community forum, a public zone of 12 feet (366 cm) or more is typical
Which distance of personal space is involved when giving a verbal report to a group of nurses? 1 2 ft (61 cm) 2 3 ft (92 cm) 3 9 ft (274 cm) 4 13 ft (396 cm)
3 According to the circular transactional model, the referent motivates one person to communicate with another, initiating the communication process. Communication channels are means of sending and receiving messages through visual, auditory, and tactile senses. The message is the content of the communication. It contains verbal and nonverbal expressions of thoughts and feelings. The environment is the setting for sender-receiver interaction. Environmental distractions are common in health care settings and interfere with messages sent between people.
According to the circular transactional model, which element motivates one person to communicate with another? 1 Channels 2 Message 3 Referent 4 Environment
3, 4, 5 Inappropriate verbalization, inability to articulate words, and difficulty in comprehending can make communication difficult. Inappropriate verbalization is the inability to use appropriate verbal expressions in the form of words. Inability to articulate words, or dysarthria, is the inability to clearly pronounce words. Difficulty in comprehending is the inability to understand another's expression. Difficulty in sitting and inability to draw pictures is a condition unrelated to speech and communication.
Following an assessment, the nurse finds that a patient has difficulty speaking. Which observations of the patient's speech and behavior would lead the nurse to this conclusion? Select all that apply. 1 Difficulty in sitting 2 Inability to draw pictures 3 Inappropriate verbalization 4 Inability to articulate words 5 Difficulty in comprehending
2 Lateral violence can be dealt with by using assertive communication. Simple assertive statements include referencing the person you are addressing, the behavior that is a problem, and its effect. Avoiding the situation, becoming defensive, or making sarcastic remarks does not help to resolve the problem.
The nurse asks another nurse how to collect a laboratory specimen and is told, "Why don't you figure it out?" Which would be the best response? 1 Say nothing and walk away. Find a different nurse to help. 2 "When you brush me off like that, it takes me even longer to do my job." 3 "Why do you always put me down like that?" 4 "I guess I just enjoy having you make fun of me."
2 The nursing process consists of five phases: assessment, diagnosis, planning, implementation, and evaluation. In the evaluation phase, the nurse compares the actual and expected outcomes, and identifies the factors affecting outcomes. Based on these, the nurse modifies the nursing care plan. In the planning stage, the nurse documents expected outcomes. Assessment involves assessing the patient and taking the patient's history. The implementation stage includes implementation of nursing interventions and delegation of the work.
When caring for a patient, the nurse identifies factors that affect the outcomes of the treatment. To which phase of the nursing process does this nursing activity belong? 1 Planning 2 Evaluation 3 Assessment 4 Implementation
2 The consent zone of touch is a special zone that is involved during tasks such as replacing teeth. This zone requires permission for touching. The social zone is a special zone that does not require permission for touching; it includes the arms, hands, shoulders, and back of patients. The intimate zone is a special zone that requires great sensitivity. The vulnerable zone is a special zone that needs special care.
Which special zone of touch is involved during teeth replacement? 1 Social zone 2 Consent zone 3 Intimate zone 4 Vulnerable zone
1, 2, 4 Actively listening, sharing empathy, and asking relevant questions are the correct means of therapeutic communication. These techniques encourage the patient to express ideas and feelings openly. Giving personal opinions, confronting the patient, and leaving the patient in distress are nontherapeutic techniques that may block communication.
A 35-year-old athlete becomes aggressive when not allowed to be ambulatory due to a fractured leg. The patient tries to get out of the bed unattended and falls. Which therapeutic communication techniques should the nurse apply in attending to the patient? Select all that apply. 1 Listen actively. 2 Share empathy. 3 Give personal opinions. 4 Ask relevant questions. 5 Confront the patient. 6 Leave the room if the patient is shouting.
4 When there is a difference of opinion between the nurse and the patient, it is important for the nurse not to force ideas on the patient. Instead of showing disapproval, the nurse should try to know more about the situation and explore the patient's views. Telling the patient not to think about it would prevent the patient from communicating further. It is an unethical nursing practice for the nurse to tell a patient that the nurse does not want to talk about the topic. Telling the patient that it is a bad idea would offend the patient and prevent the patient from opening up.
An elderly patient who is critically ill asks the nurse about assisted suicide. The nurse is ethically opposed to assisted suicide. Which is the most appropriate response by the nurse? 1 "You should not think about it." 2 "I don't want to talk about it." 3 "This is a bad idea and you should not talk about it." 4 "You have been thinking about it; let us discuss more about how you feel."
