CHAPTER 8 PREP U

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 Empathy is the ability to identify with client feelings. Congruence refers to feelings that match the expressions of the client. Positive regard means conveying genuine care to clients without passing any negative judgment on them.

The nurse observing an interaction between a mother and daughter appropriately identifies the interaction as which communication zone?

Intimate The interaction between parents and children is likely to occur in the intimate zone. The distance between close friends who are interacting is the personal zone. The distance when interacting with acquaintances is the social zone. The public zone occurs when communicating with an audience or small group.

The nurse is using nonverbal communication when caring for a group of clients. Which situation(s) reflects nonverbal communication? Select all that apply.

The nurse is maintaining eye contact when changing a client's dressing. The nurse has a smile when being thanked for caring for a family member. The nurse assess a client is in pain from a grimace. Examples of nonverbal communication include eye contact, using facial expressions, and assessing a client's facial expressions. Use of the SBAR tool and providing a brochure are examples of written communication.

The newly hired nurse is collecting assessment data for an upcoming surgical procedure from a client who speaks English 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?" The nurse should be careful to use lay terminology when speaking with clients unless the nurse knows the client is a health care professional. The client may not understand what a cholecystectomy is. The other questions are appropriate and the client should be able to understand them.

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?

Be silent and allow the client to continue speaking when ready. 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 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 The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.

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.)

Use an electronic translator. Contact a telephone-based medical interpreter. Request assistance from an agency interpreter. 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 HIPAA 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. Speaking loudly will not assist the client in understanding another language.

A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:

eliminate as many distractions as possible. Factors that distort the quality of a message can interfere with communication at any point in the process. These distractors might be from the television, or from pain or discomfort experienced by the client. Visitors may remain in the room as long as the mother agrees and they do not interfere with the education session. It may also be beneficial for others to learn the care in the event that they too will be caregivers for the infant. For this reason, it is best for the client's partner to remain in the room.

A client arrives at a crisis center in a state of bipolar mania. The client has a flight of ideas and it is difficult for the nurse to obtain an adequate intake assessment. Which statement or question will elicit the most specific information?

"Are you allergic to any medications?" The closed question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. The only closed question among the answer options is, "Are you allergic to any medications?" All of the other answer options are open-ended questions, which would be difficult for a person in a state of bipolar mania to answer with specific, succinct, helpful responses.

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. A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse's and do not represent those of the employer. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly.

The client is an 18-month-old in the pediatric intensive care unit. The client is scheduled to have a subgaleal shunt placed tomorrow, and the client's mother is quite nervous about the procedure. The nurse tells the client's mother, "The surgeon has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication?

False reassurance False reassurance minimizes the client's concerns and feelings and is providing assurance not based on fact. Rescue feelings occur when a nurse feels a strong urge to personally try to fix the client or family member's problem. The nurse is not giving advice or being moralistic in this scenario.

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 and physical therapist are engaging in interpersonal communication, which occurs between two or more people with the goal to exchange messages. Intrapersonal communication, or self-talk, is the communication that happens within the individual. Small-group communication occurs when nurses interact with two or more individuals. Organizational communication occurs when individuals and groups within an organization communicate to achieve established goals.

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 During the orientation phase, the nurse discusses with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the nurse and client acknowledge that the agreement on which the relationship is based is concluding. There is no evaluation phase of the nurse-client relationship (evaluation is the final step in the nursing process).`

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. Preferences regarding space and territoriality vary greatly. A useful strategy to foster good communication is to note, and act on, client cues. While preferences are often culturally rooted, knowing a client's culture does not provide all the data a nurse needs in order to accommodate variables around positioning. Rigid parameters are likely to be simplistic, and explicitly asking the client may make him feel uncomfortable.

When communicating with clients, nurses need to be very careful in their approach. This is particularly true when communicating using:

medical terminology. Nurses are socialized into health care or medical jargon, but the average client is not. To effectively educate and communicate, the nurse take care to limit medical jargon. Nurses are less likely to envounter communicaiton problems when providing written materials, demonstrating an action, or using audio-visual materials, as these methods are typically more intuitive to clients.

Paramedics arrive in the emergency department with a client who was in a motor vehicle collision. The paramedic reports that the driver was restrained, the car was traveling about 30 miles per hour (48 km/hr), and the air bags were not deployed. The paramedic continues to report that 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?

"All of the people got themselves out of the car?" A validation question or comment serves to validate what the nurse believes the nurse has heard or observed. Asking for additional information that was not reported is not validating the report given by the paramedic.

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." When it comes to treatment decisions, the nurse should avoid giving advice, thus reserving the right of each person to make one's own choices on matters affecting health and illness care. The nurse should share information on potential alternatives, promote the client's freedom to choose, and support the client's ultimate decision. Giving advice, avoidance, and providing false reassurance are all nontherapeutic forms of communication.

When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is:

"The thought of having surgery is keeping you awake." Reflection means repeating or paraphrasing the client's own statement back to the client to verify that the nurse understands what the client is saying. identifying the main emotional themes. Saying that the surgery sounds scary does not accurately reflect this client's statement. The other answers are offering false reassurance, which is not reflection nor therapeutic communication.

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?" Summarization highlights the important points of a conversation or interaction. Reminding the client that the diet plan and new medications were discussed best summarizes the appointment. The other answers do not review the topics discussed.

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." The statement "You are hoping to figure out the cause of your extreme fatigue during this hospital stay" focuses on the main problem that the client has been reporting and the goal for this admission. The other statements demonstrate the communication technique of clarifying.

Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached?

Empathy 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.

Which activities take place during the working phase of the nurse-client relationship? Select all that apply.

The client participates actively in the relationship. The client genuinely expresses concerns to the nurse. The working phase of the nurse-client relationship involves the client actively participating in working toward goals and genuinely expressing concerns and feelings to the nurse. The identification of goals and roles of the relationship occurs in the orientation phase. Identifying that goals have been accomplished is characteristic of the termination phase.

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 Empathy, positive regard, and a comfortable sense of self were among the key ingredients. Empathy is an objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting yourself in another person's circumstances, and imagining what it would be like to share that person's feelings. Communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions or regard with the patient and family. Comfortable sense of self is part of the nursing confidence in caring for clients. Analysis is part of the nursing process and not the key elements of therapeutic communication.

A client who underwent a hysterectomy 4 days ago says to the nurse, "I wonder if I'll still feel like a woman." Which response would most likely encourage the client to expand on this and express concerns in more specific terms?

"Feel like a woman . . ." The best response of the options listed is the statement "Feel like a woman..." This response is a reflective comment, which allows the client to reflect and elaborate on feelings. Remaining silent is a skill that is appropriate many times, but not the most appropriate in the situation at hand. Asking a yes/no question such as "Do you want more children?" or "Do you feel like you are not a woman?" does not encourage the client to reflect and elaborate on feelings.

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." The nurse needs to be truthful. A client who is given false information will soon distrust the nurse. If the nurse is not sure about something, the nurse should admit not knowing the information and inform the client he or she will seek an answer rather than make a comment that may be an error. The nurse should neither confirm nor deny the two conditions could be related until the nurse has reviewed trigeminal neuralgia. The nurse should not avoid the question by directing the client to ask the health care provider. Asking the client about ear pain at the time of the trigeminal neuralgia diagnosis implies that the client knows more than the nurse and may lead to mistrust on the part of the client.

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?" The use of the clarifying question or comment allows the nurse to gain an understanding of a client's comment. In this scenario, the nurse is asking how many times the client has been pregnant. Gravida refers to the number of pregnancies, whereas para refers to the total number of live births. Confirming the client has four children is a form of validating what the client said. The age and/or term of the children does not clarify the original question asked by the nurse.

The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. What is the most appropriate response by the nurse to decrease the client's anxiety?

"I will start an IV that will add fluids directly to the blood stream." The nurse should explain the procedure and its purpose. The nurse telling the client that it should not take much time does not convey the purpose of the procedure. It is unnecessary for the nurse to inform the client about the technical details of the catheter. Additionally, the nurse should not give false reassurance by telling the client that the procedure will not be painful.

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." An authoritarian approach assumes that the professional will make decisions for the client. The statement about surgery being the only option and that the client needs it reflects an authoritarian approach. The statement about not living and grandchildren being upset if they lost their grandfather are guilt inducement statements. Telling the client that it is the client's choice and asking about the client's understanding reflects an advocacy approach.

A nurse has developed strong rapport with the spouse of a client who has been receiving rehabilitation following a debilitating stroke. The spouse has just been informed that the client is unlikely to return home and requires care that can only be provided in a facility with constant nursing care. The client's spouse tells the nurse, "I can't believe it's come to this." How should the nurse best respond?

"This must be very difficult for you to hear. How do you feel right now?" Acknowledging the difficulty of the situation for the spouse is empathetic, and asking the spouse to elaborate on feelings may be therapeutic as well as provide insight into the spouse. Asking about the reasons underlying the care team's recommendation is less likely to be of benefit and may encourage the spouse to find fault with the recommendation. Attempting to redirect the spouse to a positive outlook at this early point is insensitive. Pointing out that the health care team has the client's best interest at heart might come across as defensive, and questioning what would help the spouse accept the situation is dismissive of the spouse's feelings and discourages the spouse from sharing feelings.

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. During the planning step of the nursing process the nurse develops and prioritizes an individualized plan of care in partnership with the client, family, and others as appropriate. The client with mental or physical limitations should be included in the plan as much as possible. A sign language interpreter allows the client to participate fully in the plan of care. Consulting with the client's children is not as beneficial because it places them in the difficult position of translating while experiencing the emotional strain of the parent's illness. A TTD line can assist in communication but is not as helpful as a medical interpreter. Consulting the oncology nurse specialist is not as helpful in communicating with this client as an interpreter.

Which is a skill appropriate to use in therapeutic communication?

Control the tone of the voice to avoid hidden messages. Conversation skills used in therapeutic communication include controlling the tone of one's voice so that exactly what is intended is conveyed and not any hidden message. Periods of silence have an important role in conversations because they allow for reflection. The nurse should avoid using cliches, and the conversation should be flexible.

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 An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. Sympathy is the expression of sorrow for someone's situation, involving compassion and kindness. Sympathy shifts the emphasis from the client to the nurse, as the nurse shares feelings and personal concerns and projects them onto the client. Curiosity is a strong desire to know or learn something. Empathy is perceptive awareness of what a client is experiencing. Humility is a modest or low view of one's own importance.

When attending a staff meeting, a nurse is participating in what type of communication?

Small-group communication A nurse is participating in small-group communication when attending a staff meeting. Small-group communication occurs when nurses interact with two or more people. To be functional, members of the small group must communicate to achieve their goal. Examples of small-group communication include staff meetings, client care conferences, teaching sessions, and support groups. Intrapersonal communication, or self-talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the client and family. Interpersonal communication occurs between two or more people with a goal to exchange messages. Most of the nurse's day is spent communicating with clients, family members, and members of the health care team. The ability to communicate effectively at this level influences your sharing, problem solving, goal attainment, team building, and effectiveness in critical nursing roles. Organizational communication occurs when people and groups within an organization communicate to achieve established goals.

The nurse should consider which client aspect as nonverbal communication?

The client's tone of voice A person communicates by gestures, facial expressions, posture, space, appearance, body movement, touch, vocal tone, volume, and rate of speech. All are examples of nonverbal communication. A client's accent, religious practices, values, and beliefs pertain to the client's culture, ethnicity, country of origin, and personal experience. They are not elements of nonverbal communication.

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. Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication.

A client arrives at the emergency department after experiencing several black, tarry stools. The nurse should assess for the cause of the client's complaint by:

asking the client whether the client has recently taken ferrous sulfate (iron) or bismuth subsalicylate. Both ferrous sulfate and bismuth subsalicylate can cause darkening of the stool, and either may be the causative agent in this case. Guaiac testing would only indicate the presence of blood. Food or drug allergies do not produce black, tarry stools. This client should be NPO, but implementing this intervention does not help determine the cause of the black, tarry stools.

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. Establishing eye contact is the first action with all clients, especially nonverbal clients, prior to touching the client. Nonverbal clients are not necessarily hard of hearing. It is always good to speak to a client in a pleasant tone of voice and not "loudly," as well as to use multiple forms of communication and to verbalize all steps of the nursing assessment when interacting with clients. These actions, however, are not the first actions.

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. One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice. When a client feels that a nurse is being judgmental, the client might withhold significant information. The nurse needs to develop sensitivity to the unique challenges presented by each client. A urine drug screen may eventually be ordered but is not necessary at this time. There is no evidence the client wants drug rehabilitation at this time. There is no evidence that the skin infection is secondary to the drug use.

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. Touch is the most highly developed sense at birth. Tactile experiences of infants and young children appear essential for the normal development of self and awareness of others. It has also been found that many older people long for touch, especially when isolated from loved ones because of hospitalization or long-term care facility care. Vision, taste, and hearing are not as fully developed as touch in the neonate.

A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because the nurse has not performed wound care on a complex wound in the past. Using effective intrapersonal communication, this nurse should:

tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. Intrapersonal communication, or self-talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the client and family. Understanding the importance of intrapersonal communication can also help the nurse work with clients and families whose negative self-talk affects their health and self-care abilities. Speaking directly to the client, a UAP, or charge nurse is interpersonal communication, not intrapersonal. This duty cannot be delegated to an UAP. The nurse should not ask the charge nurse to change the assignment but could ask for help in dealing with the complex wound.

A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:

involve the child's stuffed animal in the educational session. Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy. The use of music, art, and interior decorations might help put the client at ease. A client with newly diagnosed human immunodeficiency virus (HIV) infection will find it difficult to discuss sexual history or genital warts in an area that lacks privacy. A toddler might find it easier to communicate if a parent, favorite stuffed animal, or blanket is nearby. The parent should not be asked to leave the room and this may cause panic or anxiety in the child. A 3-year-old child will not be able to read written materials. Showing the child the catheter may frighten the child.

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. SBAR, which stands for Situation, Background, Assessment, and Recommendations, provides a consistent method for hand-off communication that is clear, structured, and easy to use. The S (Situation) and B (Background) provide objective data, whereas the A (Assessment) and R (Recommendations) allow for presentation of subjective information. Discussing the situation occurs during the (Situation) component of SBAR reporting. Detailing the client's past medical history is not a component of SBAR. Providing detailed findings of the head to toe assessment does not occur during SBAR reporting.

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? Select all that apply.

"Cheer up. Tomorrow is another day." "Your doctor knows best." "Don't worry. You will be just fine in another day or two." "Everything will be all right." A cliché is a stereotyped, trite, or pat answer. Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Clients tend to interpret them as a lack of real interest in what they have said. For example, even though the common question "How are you?" could start a conversation, it can cause a problem if the client hearing this suspects that the nurse is not sincerely interested in how he feels. Statements such as: "Everything will be all right," "Don't worry," and "Cheer up" impede communication and foster false hope. Stating your doctor knows best can lead to powerlessness in the client. On the other hand, acknowledging that the client has just received a lot of information and that it is understandable if the client is struggling to process it all is empathetic, and offering to talk about it opens up a line of communication rather than closing it.

A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?

"Have you ever thought of laser surgery?" "Have you ever thought of laser surgery?" is a therapeutic response and encourages the client to express the client's own views. Statements such as, "You should try laser surgery"; "Why don't you try laser surgery"; and "My grandfather also benefited from laser surgery" are nontherapeutic and are equivalent to giving advice.

A nurse is caring for a client with a diagnosis of metastatic lung cancer. The nurse finds the client sitting in a chair while staring out the window. What statement by the nurse communicates concern and caring about the client?

"I can imagine you have many concerns about your health. Tell me what is on your mind." Offering false assurances by telling the client he or she will be fine or okay is not therapeutic. Giving advice such as telling the client to talk to friends and family focuses on the nurse's experiences and opinions and not on the client's needs or concerns. A client may believe he or she must do what the nurse says, even though the advice might not work well for the client. Empathy and the simple action of asking what is on the client's mind opens up lines of communication for the client to express 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 the IV location needs to be changed." The nurse uses therapeutic communication by both acknowledging the client's anxiety and giving honest information that another IV line needs to be started. Telling the client that infiltration is causing pain but will be relieved upon removal of the IV line does not address the client's anxiety and does not inform the client about restarting another IV line. Also, the nurse telling the client to take deep breaths, or stating that the procedure is minimal and will be over soon, does not consider the client's anxiety. Finally, telling the client that "many clients experience this" is generalizing and is not appropriate.

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?" Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. By retaining this quality, you can establish successful helping relationships without appearing cold or stern. The statement "I am so sorry you are going through this" demonstrates sympathy. Sympathy differs from empathy because it shifts the emphasis from the client to the nurse as the nurse shares feelings and personal concerns and projects them onto the client, limiting the ability to focus objectively on the client's needs. Asking about why the client is crying is part of information gathering but is not empathy. Stating that sitting in the dark will not cure cancer is an abrasive statement that may work against the nurse-client relationship.

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?" Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Acknowledging the client's state, "I see you are upset" and asking the open-ended question, "would you like to talk" best demonstrates the use of empathy and helps the nurse become effective at providing for the client's needs while remaining compassionately detached. Sympathy, such as saying sorry, is not supportive and asking a closed question does not allow the client to express his or her concerns or fears. An offer to call someone is an example of avoidance, and makes the nurse appear uncaring. Telling the client not to worry is an example of giving false reassurance and is nontherapeutic and can give the client false hopes and expectations.

A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication?

"I think there is a better way to handle this." Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a non-defensive manner. "I" statements—"I feel . . ." and "I think . . ."—play an important role in assertive statements. They communicate personal feelings and preferences without expressing a judgment or blaming another person.

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." Sharing information about why the removal of the sutures hurts and is taking longer is a teaching moment which helps the client make better decisions about health care. Telling the client not to wait so long for removal is not therapeutic because it diminishes the client's ability to make choices. Changing the subject is not therapeutic and is a way for the nurse to avoid listening and addressing the client's concerns. Telling the client it will not hurt if the client relaxes is an example of false reassurance.

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." The response, "Just take your time. I am listening." allows the client permission to collect thoughts while also expressing emotion and lets the client know the nurse is there for the client. Using appropriate periods of silence rather than "talking away" the client's feelings is empathetic. The response "I know how you feel" does not focus on the client's feelings. Stating "It's okay to cry" or "Take some time for yourself" suggests that the nurse is granting the client permission to experience the client's own feelings, which the client does not need.

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." The nurse-client relationship focuses on the client, is goal-directed, and has defined parameters. The orientation phase consists of introductions and the establishment of an agreement between the nurse and the client about their mutual roles and responsibilities. This is accomplished by the nurse asking if the client has any concerns about the care. The nurse would not work to meet the nurse's needs, give personal information to the client, nor provide false reassurance to the client.

A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication?

"Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you." Nurses often rely on verbal and nonverbal cues from clients to verify whether client objectives or goals have been achieved. It is therapeutic to allow for a pause in the communication by giving the client time to think about the situation and what has happened. Rescuing, false reassurance, and moralistic judgement are not therapeutic and could lead to client disappointment, minimizing the client's concerns, or inference on what is the "right" way to feel.

A nurse visits a female victim of sexual assault. During the visit the client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse?

"Tell me more about the aspects that make you feel as if it happened yesterday." The nurse should make statements that would facilitate an expression of feelings from the client. The nurse should encourage the client to express her fears and insecurity. This conveys that the nurse is there to provide support. This type of therapeutic approach happens during the working phase. The nurse should avoid giving an opinion and should in fact allow the client to hold on to the feelings. Making the client realize that the rape occurred a month ago would block communication.

A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation?

"What day of the week is it?" Asking the client to identify the day of the week represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking closed-ended questions, which are answered with a simple yes or no response. The remaining responses are all closed-ended questions and therefore would not provide an accurate assessment of the client's orientation.

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?" When obtaining a nursing history, use the open-ended question technique to allow the client a wide range of possible responses. The greatest advantage of this technique is that it prevents the client from giving a simple "yes" or "no" answer, which limits the client's response. The questions related to medication use, allergies, and an advanced directive are examples of closed communication, in which only one or a few words are required for an answer.

Which is an open-ended question?

"Why did the health care provider prescribe this medication for you?" Open-ended questions (e.g., "Why was this medication prescribed for you?") give the client an opportunity to express what the client understands and prevent the client from answering with just "yes" or "no" or some other one-word response. The other three responses require only a one-word response (e.g., "yes" or "no") and so are closed-ended questions.

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." To understand the client's perspective, the nurse uses therapeutic communication techniques to encourage verbal expression. The use of active listening facilitates therapeutic interactions. "You seem unsure" demonstrates that the nurse was actively listening and has decoded the content and feelings of the client. "Tell me your concerns about your surgery" is an open-ended statement which will allow the client to express themselves. Giving clients the opportunity to be heard helps them organize their thoughts and evaluate their situation more realistically. "I understand you are confused" and "I understand that you are not sure" are examples of rescue feelings on behalf of the nurse. Saying I understand implies the nurse has the knowledge to fix the problem, especially followed by an explorative statement. Asking the client what he or she thinks he or she should do or why the surgery is not needed will put the nurse in the position to judge the response. "Please let me know if you decide to postpone the surgery until you are no longer unsure" suggests that the client should postpone the surgery and is an example of giving advice. The nurse should not give opinions, attempt to sway a client's opinion, or avoid an uncomfortable discussion.

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." Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives.

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. The SBAR technique of communication has numerous applications, including nurse-physician communication surrounding acute client developments. The technique is not normally applied in client education or in communication between the health care team and patients' families.

Which characteristics would indicate a professional relationship? Select all that apply.

An emphasis on addressing the client's needs in the current situation The relationship ending with goal achievement -The nurse-client relationship differs from a social or intimate relationship. Within the nurse-client relationship, the nurse assumes the roles of a professional and a helper. The client is the one seeking help. The nurse-client relationship focuses on the client, is goal directed, and has defined parameters. In the professional relationship, the nurse also assesses how the nurse's own role, communication skills, personal history, and values may be affecting the interactions. The nurse uses self-disclosure only for what is appropriate for the client's benefit. A social relationship focuses on both parties, with open sharing assessment of how own needs for enjoyment are met in the relationship.

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. Rapport is a feeling of mutual trust between nurse and client. Kindness is the quality of being friendly, generous, and considerate. Active listening and the use of silence are communication techniques, but they do not necessarily develop mutual trust between the nurse and client.

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply.

Are you ready to get out of bed?" "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Does it hurt when I touch you here?" The closed-ended 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 questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. Closed-ended questions are often a barrier to effective communication. Asking what the client does for fun or what the client's future plans are facilitates communication between the client and the nurse.

A client reports to a primary health care provider with aggravated chest pain. The health care provider prescribes a stress test. The client tells the nurse about not wanting to take the test and wanting to continue taking medication for now. Understanding that the client is anxious, which action should the nurse take first to provide education needed for this client?

Ask the client "What has your health care provider shared with you about stress tests?" To reassure the client, the nurse should provide education about the stress test so the client can make an informed decision. The nurse should not assume the health care provider has provided complete information about the stress test. By first inquiring with an open-ended question, the nurse allows the client to share his or her knowledge. Then the nurse can provide the education needed, which may include a booklet or other approaches based on the client's learning style. By providing information without first understanding the client's knowledge, the nurse may be repeating something the client already knows.

A nurse states the following to another nurse who is constantly forgetting to wash hands between clients: "It looks like you keep forgetting to wash your hands between clients. It's really not safe for your clients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech?

Assertive The communication is an example of assertive speech. Assertive communication is the ability to stand up for oneself and others using open, honest, and direct communication. Aggressive communication involves asserting one's rights in a negative manner that violates the rights of others. Therapeutic speech is speech a nurse uses when communicating with a client that has a specific purpose or goal. Nonassertive speech would be the opposite of assertive speech, as described above.

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 Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge.

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 The nurse shoulld try to establish a good rapport with the client and use therapeutic communication. In doing so, the nurse should be sensitive to all needs of the client—including physical and emotional. The degree to which clients are physically comfortable influences their ability to communicate. Once rapport is established, the nurse and client can communicate about pain management options, although perhaps not in great detail, as the client may not be able to tolerate lengthy explanations. The nurse sharing the nurse's own family and personal history of back pain takes the focus off of the client and is not sensitive to the client's needs. Telling the client that back surgery will likely alleviate pain completely is providing false assurance, as this is not necessarily true.

During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking, "How many times have you been hospitalized this year for your back pain?" This is an example of which type of question?

Closed question An open-ended question is often used when the nurse is obtaining a nursing history and allows the client to reply with a wide range of possible responses, thus encouraging free verbalization. A closed question is answered by one or two words, often "yes" or "no." A sequencing question is used to place events in a chronological order and to investigate a possible cause-and-effect relationship. A reflective question involves repeating what the person has said or describing the person's feelings.

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. If an interpreter is necessary, the nurse should use a professional interpreter recommended by the facility or agency. It is inappropriate to rely on the client's family members or friends for this service. If the fellow nurse is not fluent in the language, then this nurse is not likely to be effective as an interpreter.

While assessing a client, the nurse notices that the client seems to be distracted from the questions being asked. The nurse attempts to identify factors that may be affecting the communication. What would the nurse identify as an internal influencing factor?

Experience The client's past experience, an internal influence, may affect the nurse-client communication. Noise, privacy, and ambience are external factors that affect the communication between a nurse and client. Other internal influences that may affect the nurse-client communication are cultural background and beliefs.

The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?

Encouraging elaboration Encouraging elaboration involves making simple statements that indicate active listening and comprehension on the part of the nurse and that prompt the client to continue talking. This technique helps the client to describe more fully the concerns or problems under discussion. Clarification involves asking a follow-up question about a statement made by the client to clear up some point that the nurse is not sure about or to elicit more specific details. Reflection and restatement involve the nurse repeating back to the client a comment made by the client to ensure that the nurse has correctly heard or understood the client.

In a helping relationship, the nurse would most likely perform what action?

Establish communication that is continuous and reciprocal. In a helping relationship, the nurse would most likely establish communication that is continuous and reciprocal. The goals established for the client must be set in a specific time frame to be effective. The nurse would not encourage the client to independently explore goals. Goal exploration would be done with both the nurse and the client. The relationship that should be established between the nurse and the client is not reciprocal, but rather a formal relationship in which the nurse is the helper and the client is the one being helped.

When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive?

Facial expressions The face is the most expressive part of the body. Eye contact or the lack thereof, posture, hand gestures, and silence are other methods of nonverbal communication but do not provide as much information about what the person is communicating as do facial expressions.

A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique?

Giving false reassurance False reassurance means giving reassurance that is not based on the real situation. It is an attempt to alleviate the client's concerns about a situation by confidently saying that everything will be fine when, in fact, the nurse has no grounds for making such a statement. It minimizes the client's feelings and could cause the client to have false hope, be disillusioned when difficulties arise, and ultimately lose trust in the nurse. Seeking clarification means asking follow-up questions or making follow-up statements to clarify or gain more specific information about something the client has said. Giving information involves sharing accurate information about the client's health and well-being in a timely manner. Encouraging elaboration is a technique used to help the client describe more fully the concerns or problems being discussed.

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 There are three forms of communication channels: kinesthetic, verbal, and visual. Kinesthetic communication is the use of touch to convey emotional support for the client. The verbal mode of communication uses words to relay information, and visual communication uses gestures or actions to communicate. Body language is a broad term for nonverbal communication that allows the nurse to observe uncommunicated behaviors of the client and can include several behaviors including: touch, eye contact, facial expressions, posture, gait, gestures, general physical appearance, grooming, sound, and silence.

When caring for a psychiatric client, a nurse would make a formal contract with the client during which phase of the nurse-client relationship?

Orientation phase In the psychiatric setting, the orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are used as a therapeutic tool to help a client develop more insight and control over behavior. The working phase consists of the nurse and client working together to achieve the client goals established in the orientation phase. The termination phase consists of evaluating the client's progress toward meeting the goals and concluding the relationship. There is no intimate phase in the nurse-client relationship.

The nurse makes a contract with the client during which phase of the nurse-client relationship?

Orientation phase The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase.

A nurse is caring for a client who sustained head trauma. The client is in a medically induced coma and on mechanical ventilation. The client's parent is at the bedside in tears. The parent states, "I just want my child to know I am here." To address the needs of the parent and the client, what would be the nurse's most appropriate response?

Place a chair next to the bed and encourage the parent to hold the client's hand. Despite its individuality, touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others. The nurse may feel it is appropriate to place the client's hand on the parent's hand; however, the nurse should not provide false hope. The nurse should not leave the parent alone to grieve; the nurse should show the parent how to use comforting communication. The client is in a chemically induced coma and will not be able to see pictures that are displayed in the room.

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?

Recommendation This information is the recommendation of the nurse regarding the client's condition. It is not discussing background information related to the client, the situation of the client, or any assessment information related to the client.

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 During the termination phase of the nurse-client relationship, the nurse and the client review health changes and how the client has dealt with physical and emotional responses. During the orientation phase of the nurse-client relationship, the nurse and client work toward establishing trust and rapport. During the working phase of the nurse-client relationship, the nurse attends to the physical health care needs of the client and develops solutions that the client will act on.

The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important?

Speak directly to the client. When utilizing an interpreter, speak clearly in a conversational tone and directly address the client. While a client may be more comfortable having a family member present, this is not required. The nurse should not give all of the discharge instructions at once, which is likely to overwhelm the client, but provide discharge teaching in brief, manageable increments. Interpreters should not be asked to translate written information; instead, the nurse should verbally explain the brochure, or a copy should be obtained in the client's native language.

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." It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, in the scenario in which the client stares at the floor while claiming to feel fine, the nurse should investigate further because of the incongruence between the client's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication is effective and no further investigation is warranted.

A nurse and client are in the working phase of the helping relationship. What outcome statement developed by the nurse and client correlates with this phase?

The client will express feelings and concerns to the nurse. The working phase of the nurse-client relationship is when the nurse and the client work together to meet the client's physical and psychosocial needs. The client expressing feelings and concerns demonstrates the work that is going on to meet the specific goals that are set in the orientation phase. Determining when and where they will meet is established in the orientation phase of the relationship. Identifying the goals that have been accomplished during the relationship is established in the termination phase of the relationship.

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? Select all that apply.

The client's physician The nurse from the oncoming shift The unit's mental health technicians Unless the client has specifically given permission to provide information to family and friends, this information should remain among individuals on the health care team who are directly involved with care of the client.

Which nursing actions would most likely help improve communication with clients and achieve a more effective helping relationship? Select all that apply.

The nurse controls the tone of voice so that it conveys exactly what is meant. The nurse makes statements that are as simple as possible, gearing conversation to the client's level. The nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations. The following nursing actions would most likely help improve communication with clients and achieve a more effective helping relationship: The nurse controls the tone of voice so that it conveys exactly what is meant; the nurse makes statements that are as simple as possible, gearing conversation to the client's level; the nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations. The nurse attempts to remain focused on the topic at hand but must allow the client to diverge to another topic, as appropriate. The nurse must be careful not to use words that might have different interpretations than what the nurse meant. The nurse should admit a lack of knowledge to the client to avoid undermining the client's confidence in the helping relationship.

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. During the initial phase of the nurse-client relationship the nurse assesses the client's verbal and nonverbal communication. Shaking the head and requests to repeat what has been said points to a hearing deficiency. Facing the client, speaking slowly and clearly, and providing a visual demonstration is effective for communicating with individuals with a hearing impairment. Making a mental note to repeat instructions is a poor nursing action regardless of the communication difficulties of the client, because the nurses failed to let the client know the plan to repeat the instructions. Stopping the instruction and getting a home health nurse to administer the medication demonstrates that the nurse interpreted the client's communication as unwilling or as an inability to self-administer. This misinterpretation may result in an unnecessary healthcare expense. The nurse asking the client if he or she is worried demonstrates that the nurse is ignoring or not paying attention to the client's communication abilities.

A nurse who is caring for newborn infants delivers care by utilizing the sense that is most highly developed at birth. Which example of nursing care achieves this goal?

The nurse gently strokes the baby's cheek to facilitate breastfeeding. The sense most highly developed at birth would be the sense of neurological reflex. The nurse gently stroking the baby's cheek to have the baby turn toward the stroke is a developmental reflex. The nurse would not use a loud voice or wear colorful clothing while caring for a newborn. The infant is not at the stage of development where playing "peek-a-boo" would be appropriate.

A nurse is communicating the plan of care for a client who is unconscious. Which nursing actions best facilitate this process? Select all that apply.

The nurse is careful what is said in the client's presence because hearing is the last sense to go. The nurse assumes the client can hear and discusses things that would ordinarily be discussed. The nurse speaks with the client before touching the client. The nursing actions that best facilitate communication with a client who is unconscious would include being careful what is said in the client's presence because hearing is believed to be the last sense to go. The nurse would assume the client can hear and discuss things that would ordinarily be discussed. The nurse would speak with the client before touching the client. The nurse would not speak to the client in a louder-than-normal voice. The nurse would minimize environmental noises to facilitate communication. The nurse would use touch to communicate with the client.

A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.

The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond. The nurse keeps communication simple and concrete. There are several nursing actions that would be appropriate to facilitate. The nurse would maintain eye contact with the client. The nurse shows patience and gives the client time to respond. The nurse keeps communication simple and concrete. The nurse would not communicate in a busy environment because this could be distracting to the client. The nurse would not give lengthy explanations to the client regarding the care to be given. The nurse would repeat the information if no response was shared by the client.

A nurse is caring for a client who sustained a spinal cord injury and has paraplegia. The client is frustrated, crying, and tells the nurse, "I just want to die." What is the nurse's best response to the client?

The nurse says, "I can only imagine how hard this is on you. How can I help you?" Empathy is identifying with the way another person feels. An empathetic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. By retaining this quality, the nurse can establish successful helping relationships without appearing cold or stern. Sympathy differs from empathy because it shifts the emphasis from the client to the nurse as the nurse shares feelings and personal concerns and projects them onto the client, limiting ability to focus objectively on the client's needs. Instead of leaving the room, the nurse should stay to communicate with the frustrated client. Placing a warm blanket over the client's legs covers the paralyzed legs and may upset the client more. Stating "I am sorry this happened to you" is an expression of sympathy, not empathy.

When communicating with a client, the nurse uses reflection for which purpose?

To have the client elaborate on thoughts and feelings The reflective question technique involves repeating what the person has said or describing the person's feelings. It encourages patients to elaborate on their thoughts and feelings. Exploring helps clients express their concerns and solve their problems by investigating the situation, exploring how they feel about it, and what some alternatives might be. Focusing helps the client stay on the topic. Sequencing determines events in chronological order.

Which statement accurately describes the concept of feedback as it pertains to the process of communication?

The sender and the receiver use one another's reactions to produce further messages. Feedback is a person's reactions to a message that provide evidence that the person has understood the intended message. Based on one's feedback during communication, the other party can produce further messages. The other answers describe aspects of effective communication that precede feedback.

A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?

The working phase There are three phases of a helping relationship: the orientation phase, the working phase, and the termination phase. The introduction phase is not a valid phase, yet the nurse introduces oneself during the orientation phase. The scenario defines characteristics of the working phase, during which the nurse and client work together to meet the client's physical and psychosocial needs. During the orientation phase, the nurse and client establish the tone and guidelines for the relationship . The termination phase occurs when the nurse and client acknolwedge that they have met the goals of the the initial agreement or that the client would be better served by another nurse or health care provider.

To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others?

Therapeutic communication Therapeutic communication facilitates interactions focused on the client and the client's concerns. Therapeutic communication is purposive, but this is not a discrete category of communication. Intrapersonal communication is communicaiton with oneself, or self-talk. Metacommunication is communication about communication.

For which purposes would observing silence be appropriate? Select all that apply.

To allow the client time to reflect on the client's thoughts To allow the client time to reflect on communication that has occurred 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 Silence allows a pause in communication that gives the nurse and client time to reflect on the conversation that has taken place. When the nurse waits quietly and attentively, the client feels encouraged to initiate and maintain conversation. Allowing time for the nurse to think of something to say when the nurse doesn't know the answer to a question is not an appropriate use of silence; in this case, the nurse should simply tell the client that the nurse doesn't know the answer but would be happy to find out the answer, if possible.

Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?

Working phase During the working phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions. The orientation phase involves making introductions and establishing client goals. The termination phase involves evaluating client progress toward goals and concluding the relationship. There is no evaluation phase in the nurse-client relationship.

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 Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct 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. It would be ineffective to rush through a list of questions when obtaining a nursing history; it is more effective to let the client set the pace. Let the client know at the beginning of the interaction if time is limited so that the client does not feel that you are rushing because of a lack of concern or personal interest. Open-ended questions do not apply to "yes or no" answers. The client should be the person answering the questions unless unable to.

A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult:

an audiologist. A nurse who suspects a speech, language, or hearing problem should refer the client to a speech-language pathologist or audiologist. A speech-language pathologist is a professional educated in the study of human communication, its development, and its disorders. An audiologist is a professional educated in the study of normal and impaired hearing. An ophthalmologist is a medical doctor who specializes in the treatment of eye disorders. An optometrist has a practice doctorate and focuses on vision. A clinical psychologist is a behavioral health expert.

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. Effective groups have members who are mutually respectful. If a group member dominates or thwarts the group process, then the leader or other group members must confront the member to promote the needed collegial relationship. Planning a secret meeting does not solve the underlying issue. Picking a team leader who is not the dominant member will not address the dominance issue. A written warning would be inappropriate; a verbal communication is what is required among the team.

A 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 new 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:

ask to speak to the night shift nurse in private and explain how the comment made the new nurse feel. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a non-defensive manner. "I" statements—"I feel . . ." and "I think . . ."—play an important role in assertive statements. "You" statements are defensive and close lines of communication. The comment should not be ignored or the lateral violence--or displaced hositility toward a peer--will continue. It would be inappropriate to contact hospital security; the matter should be dealt with directly by the new nurse.

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. When disruptive physician behavior occurs, it is best to respond assertively and confront the physician directly. If this is not possible, ask to speak to the physician in private and address any disrespectful remarks or behaviors. Nurses should factually document the occurrence of any bullying behaviors and speak to a nurse-manager if the behavior continues.

An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is afraid of waking up during surgery. The best response by the nurse is to:

ask why the client thinks the client will wake up during surgery. Asking why the client thinks the client will wake up during surgery opens the lines of communication. Making a sweeping generalization that does not necessarily apply to a specific client hinders communication and makes the person feel insignificant. Restating the client's concern is inappropriate at this time. The nurse should not ask the surgeon to reassure the client. The nurse could ask the anesthesiologist to speak with the client to help alleviate any fears the client has.

In the provision of care and the establishment of the therapeutic relationship, the nurse must first:

be aware of one's own personality. Before a nurse can communicate therapeutically, a comfortable sense of self, such as being aware of one's own personality, values, cultural background, and style of communication, is necessary. The other answers represent important aspects of the therapeutic relationship but would occur after the nurse becomes aware of one's own personality.

When the nurse communicates with a newly admitted client, the nurse must pay particular attention to nonverbal behaviors. The nurse considers which characteristic as nonverbal communication?

client's tone of voice Nonverbal communication refers to the use of body language, such as gestures, facial expressions, posture, space, appearance, body movement, touch, voice tone and volume, and rate of speech. The other answers refer to aspects of the client's cultural identity rather than nonverbal communication.

Each of the following facilitates a therapeutic nurse-client relationship except:

closed-ended questions. Rephrasing, reflection, and active listening are essential for accurate assessment and interventions.

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 Nursing responsibilities in the nurse-client relationship entail advocating on the client's behalf. For a client who does not consent to a particular type of treatment, for which there may be alternative treatments available, the nurse can establish trust in the nurse-client relationship by advocating for the client's care needs to the client's interprofessional care team. Although it is part of the nurse's scope of practice to provide client education regarding treatment interventions, this is not the action the nurse would take to establish trust with the client. Speaking to the client's family about having this discussion potentially breaches client confidentiality and would serve to decrease trust in the nurse-client relationship. It is not within the nurse's scope to recommend that the client have the cognitive capacity assessed. While it is important to ensure the client has the capability to make informed decisions about treatment, the client's refusal for treatment stems from personal beliefs, not cognitive impairment.

A nurse is caring for a client admitted to the hospital for dehydration. The physical findings consistent with this diagnosis that the client's general appearance can nonverbally communicate to the nurse include:

easy wrinkling of the skin and sunken eyes. Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone. On the other hand, a person in good health tends to radiate this healthy status through general appearance. Although prolonged capillary refill is consistent with dehydration, slow heart rate is not. Pallor may be associated with dehydration but diaphoresis is not associated with this condition. Cold intolerance and brittle nails are consistent physiologic changes seen in clients with hypothyroidism.

A nurse is interviewing a client for the establishment of long-term care insurance. During the interview, the nurse asks questions regarding the client's past medical history. In this case, the nurse plays the role in the process of communication of the:

sender. The nurse is playing the role of the sender, which is a person or group who has a purpose for the communication and initiates and conveys the message. The receiver, or decoder, is the person or group who receive and interpret, or decode, the message. Target is not a term used to describe a role in the communication process.

A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should:

sit at the bedside and allow the client to explain the statement. Clients may or may not feel able to speak freely to the nurse. Often, the signals indicating their readiness to talk are subtle. Don't miss valuable opportunities for important communication by approaching clients with a closed mind or focusing on your own needs rather than on the client's needs. Nurses who lack confidence in their own ability to meet the challenges a client presents might become defensive in response to a client's comments. Nurse defensiveness is a huge barrier to open and trusting communication. Smiling and apologizing and ignoring the client close lines of communication. Although the unit may have been busy, it is best to listen to the client express feelings.