Chapter 8: Communication
The nurse meets with the client to teach self-administration of low molecular weight heparin. During the initial part of the training the client shakes the head and asks the nurse to repeat the instructions. What action demonstrates that the nurse has assessed the client's communication abilities?
The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe.
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process?
The nurse keeps communication simple and concrete. The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond.
The nurse is beginning an assessment on a nonverbal client. The nurse must first:
establish eye contact prior to assessing, touching, and interacting with the client.
A client has just been given a diagnosis of cirrhosis of the liver. Which statements by the nurse should be avoided because they could impede communication?
"Cheer up. Tomorrow is another day." "Everything will be all right." "Your doctor knows best." "Don't worry. You will be just fine in another day or two."
The newly hired nurse is collecting assessment data for an upcoming surgical procedure from a client who speaks the dominant language as a second language. Which statement or question made by the newly hired nurse would indicate to the nurse manager that intervention is needed?
"Do you have any questions about your cholecystectomy?"
A client was recently diagnosed with metastatic lung cancer. The nurse finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy?
"I see you are upset. Would you like to talk?"
A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question?
"I understand you have four kids; how many times have you actually been pregnant?"
A client comes into the urgent care center to have sutures removed on an arm. The nurse finds significant crusting along the suture line. The client states not having time to get the sutures removed a week prior, as directed. The nurse soaks the crust and attempts to remove the sutures. As the nurse attempts the suture removal, the client frequently pulls the arm away and tells the nurse, "You are taking too long and it is hurting a little bit. Just pull them out and get it over with." Which statement is an example of appropriate therapeutic response?
"It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them."
The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client?
"It sounds as though you are most concerned about how your children will feel."
A nurse enters the client's room and begins the process of establishing a nurse-client relationship. The nurse introduces oneself and informs the client how long the nurse will be caring for the client. What additional statement does the nurse need to communicate with the client?
"Let me know if you have concerns regarding your care."
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?
"Share with me the advantages and disadvantages of your options as you see them."
A client is reluctant to undergo surgery and is discussing it with the nurse. Which response by the nurse would reflect an authoritarian approach?
"Surgery is your only option. You need this operation."
The nurse completes the admission process of a client to an acute care facility. Which statement by the nurse demonstrates the communication technique of focusing?
"You are hoping to figure out the cause of your extreme fatigue during this hospital stay."
A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse?
"You're worried about how you will tolerate the pain associated with labor."
What nursing care behavior by the nurse engenders a client's trust in the nurse?
A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client.
In which situation would the SBAR technique of communication be most appropriate?
A nurse is calling a physician to report a client's new onset of chest pain.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse?
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client?
Approach the client with empathy and understanding and allow the client to share feelings without being judged.
A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client?
Arrange for a sign language interpreter when discussing treatment.
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication?
Assess how the client would like to communicate
A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point?
Being sensitive to the client's emotional barriers
A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take?
Contact a professional interpreter.
A nurse is discharging a client and thus terminating the nurse-client relationship. Which action should the nurse perform in this phase?
Examine goals of the relationship to determine whether they were achieved
A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment?
Pull the curtain dividing the two beds.
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out during this phase of the relationship?
Reviewing health changes
The nurse-client relationship depends on communication. Effective communication between the nurse and the client encompasses which aspects?
Sight Spoken words Observation Touch
Which guideline should a nurse use when choosing a position (location) in relation to a client during a verbal interaction?
Take note of the client's cues when choosing a position and act on these cues.
A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation?
The client stares at the floor and states, "I feel fine."
A client in a mental health unit discusses personal thoughts and feelings with the nurse. The nurse can maintain the circle of confidentiality when reporting this information to which individuals?
The unit's mental health technicians The client's physician The nurse from the oncoming shift
To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others?
Therapeutic communication
A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:
allow the client to set the pace.
Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?
analysis
A nurse is on lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. One of the physicians, who is in charge of the nurse's clients, points at the nurse and states, "That guy needs to get fired." The best response by the nurse would be to:
ask to speak to the physician in private and address the disrespectful remark.
The nurse communicates with a newly admitted client. Which nonverbal behavior will the nurse note?
client's gestures
A client has cancer, but the significant other does not want the client to know the diagnosis. The nurse demonstrates sensitivity to the significant other and works with the couple to achieve desired outcomes. What kind of behavior is the nurse exhibiting?
empathy
A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation?
empathy
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive?
facial expressions
The nurse and the physical therapist discuss the therapy schedule and goals for a client on a rehabilitation unit. What type of communication is occurring between the nurse and the therapist?
interpersonal
The nurse makes a contract with the client during which phase of the nurse-client relationship?
orientation phase
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should:
remain honest, open, and frank.
The nurse is communicating with a client following a routine physical examination. Which statement best demonstrates summarization of the appointment?
"We reviewed your plans for your new diet and medications. Do you have any other questions?"
A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse?
"I know this is hard for you. Is there any way I can help?"
A nurse is assessing a client's nutritional intake prior to admission the client has lost 10 Ib (4.5 kg) over the last 2 months. Which example best represents therapeutic communication technique?
"Tell me about the type of foods you like to eat."
The nurse is communicating with a client who begins to cry. The nurse places a hand on the client's arm and sits quietly at the client's beside. What mode of communication is the nurse using to offer caring and comfort for the client?
Kinesthetic
A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be:
aggressive
The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes?
contacting the interprofessional care team to discuss alternative treatment options
An experienced nurse has been working with a client with heart failure. The client's lungs were clear to auscultation during the morning assessment; however, the afternoon assessment revealed bibasilar crackles and tachypnea. The nurse calls to give SBAR report to the covering health care provider. In the final step of the report the nurse should:
recommend 40 mg of furosemide be administered because the client had improvement with past administration.
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:
swaddling the child and gently stroking its head.
The client is being discharged, and the nurse observes the client crying. What is the nurse's most appropriate response?
"Would you like to talk about anything before you go home?"
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. What is a characteristic of empathy?
Identifying with the client's feelings
A nurse finds that a client has infiltration around the IV line that needs to be removed. What explanation should the nurse give to reduce the client's anxiety?
"I know that you are anxious, but removal will be painless and the IV location needs to be changed."
The client is talking to the nurse about recent health problems of immediate family members and the strain the client has been under trying to care for them. The client begins to cry. What response by the nurse demonstrates the most empathy?
"Just take your time. I am listening."
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:
"What did your health care provider tell you about your need to be admitted?"
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:
have group members confront the dominant member to promote the needed team work.
A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?
orientation phase
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 neurological checks every 2 hours and the nurse should report any alterations to the health care provider. In which section should this information be relayed?
recommendation
A client presents to the urgent care clinic with ear pain. The client reports a medical history of trigeminal neuralgia. The nurse is not familiar with trigeminal neuralgia. When the client asks whether the two conditions could be related, which response by the nurse is best?
"I honestly do not remember specific details regarding trigeminal neuralgia; let me research it."
A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening?
"You seem unsure. Tell me your concerns about your surgery."
The nurse is communicating with a client who has been newly diagnosed with cancer. Which statement(s) by the nurse is nontherapeutic?
"You will be OK. Your health care provider is an excellent surgeon." "Why did you not seek help when you first noticed a problem?" "Keep your chin up. People survive this type of cancer all the time.
For which purposes would observing silence be appropriate?
To allow the client time to reflect on communication that has occurred To allow the client time to reflect on the client's thoughts To allow the client time to formulate an answer after asking the client a question To allow the client time to compose oneself when the client is upset
