Exam 1: Communication Questions

What nursing actions best promote communication when obtaining a nursing history? Select all that apply. 1. establishing eye contact 2. paraphrasing the client's message 3. asking why and how questions 4. using broad, open-ended statements 5. reassuring the client that there is no cause for alarm 6. asking questions that can be answered with a yes or no

1, 2, 4 rationale: Eye contact indicates to the client that the nurse is listening and interested. Paraphrasing is an effective interviewing technique; it indicates to the client that the message was heard and invites the client to elaborate further. Open-ended statements provide a milieu in which people can verbalize their problems rather than be placed in a situation of providing a forced response. Asking "why" and "how" questions can be threatening to the client, who may not have the answer to these questions. False reassurance is detrimental to the nurse-client relationship and does not promote communication. Direct questions do not open or promote communication.

The nurse asks questions to an older client about past experiences and listens attentively. Which therapeutic communication strategy is involved when the older client is recalling the past? 1. touch 2. reminiscence 3. reality orientation 4. validation therapy

2 rationale: Reminiscence involves recalling and discussing past experiences. Touch is a therapeutic tool used to comfort older adults. Reality orientation involves helping a confused older adult agree with the nurse's statements. Validation therapy is a psychosocial concern involved in accepting the descriptive statements made by the confused older adult.

Which psychophysiologic factors can influence communication between a nurse and a client? Select all that apply. 1. privacy level 2. emotional status 3. information exchange 4. level of caring expressed 5. growth and development

2, 5 rationale: Growth and development and emotional status are two psychophysiologic factors that influence communication between a nurse and a client. Privacy level is an environmental factor. Information exchange is a situational factor. Level of caring expressed is a relational factor.

The nurse is assessing a client with impaired hearing. Which action of the nurse is most important for establishing a good communication with the client? 1. Speaking at a normal volume 2. Reducing environmental noise 3. Getting the client's attention before speaking 4. Rephrasing rather that repeating if misunderstood

3 rationale: The first step that the nurse should take for starting a communication with a client with impaired hearing is getting client's attention before speaking. The nurse should never shout and should always speak in a normal volume. The nurse should reduce the environmental noise before starting a conversation to avoid disturbances. The nurse should always rephrase the sentences rather than repeating if misunderstood because it can cause confusion.

The nurse is communicating with an older adult who has a hearing disability. Which intervention by the nurse is beneficial to promote communication? Select all that apply. 1. giving the client a change to speak 2. assuming the client is being uncooperative 3. chewing gum while talking to the client 4. making sure that the client knows you are speaking 5. keeping the communication concise

1, 4, 5 rationale: When communicating with an older adult who has hearing disability, the nurse should give the client a chance to speak, make sure that the client knows the nurse is talking, and keep the communication concise. The nurse should not assume that the client is uncooperative if he or she does not reply or gives a delayed response. The nurse should also not chew gum while talking because this action may garble the nurse's language.

A licensed practical nurse (LPN) was hired recently. Which strategy should be applied by the registered nurse (RN) to open lines of communication between them? 1. telling 2. selling 3. asking 4. offering

3 rationale: Asking is the first strategy and begins with questions that open lines of communication between the newly hired LPN and RN. Telling is helpful when the delegatee and delegator have a new relationship. Selling is the supervision by the delegator when the delegator and delegatee have a long relationship and have been working together for a while. Offering is also a strategy that can be followed after using the asking strategy by making a suggestion.

Which theorist suggested that the goal of nursing is to use communication to help clients reestablish a positive adaptations to their environments? 1. king 2. peplau 3. nightingale 4. benner and wrubel

1 rationale: to use communication to help the client reestablish a positive adaptation to his or her environment. According to Peplau's theory, the goal of nursing is to develop an interaction between nurse and client. According to Nightingale's theory, the goal of nursing is to facilitate the reparative processes of the body by manipulating a client's environment. According to Benner and Wrubel, the goal of nursing is to focus on a client's need for caring as a means of coping with stressors of illness.

Which of these is a one-on-one communication between a nurse and another person? 1. small group communication 2. intrapersonal communication 3. interpersonal communication 4. transpersonal communication

3 rationale: Interpersonal communication is a one-on-one interaction between a nurse and another person that often occurs face to face. Small-group communication is interaction that occurs when a small number of people meet. Intrapersonal communication is a form of communication that occurs within an individual. Transpersonal communication is an interaction that occurs within a person's spiritual domain.

What is one strategy that will improve client outcomes, communication, and collaboration between all health care providers? 1. primary nursing 2. client-focused care 3. interprofessional education 4. community-based transitional program

3 rationale: Interprofessional education and collaboration is important and has a positive impact on the outcomes of client care, communication, and collaboration, which is increasingly important as the complexity of health care increases. The care models of primary nursing, client-focused care, and community-based transitional programs do not have the same impact as interprofessional education and collaboration on outcomes, communication, and collaboration.

What is the most appropriate communication strategy for the nurse working with adolescents in a clinic in a large city health center? 1. relating on a peer level 2. using typical teenage language 3. establishing a relationship over time 4. having discussions in concrete terms

3 rationale: Several meetings with an adolescent provide an opportunity to develop trust and establish a relationship. Relating on a peer level is unrealistic because the nurse is not an adolescent's peer. Using teenage language is not necessary and may even impede the establishment of a relationship. It is not necessary to use concrete terms, because the adolescent is capable of abstract thought.

How can the lines of communication be improved in a healthcare organization during the process of delegation? 1. By considering all aspects of client care 2. By selecting experienced nursing assistants as delegatees 3. By appreciating and valuing each other's cultural perspectives 4. By selecting a delegatee having similar strengths as that of the delegator

3 rationale: The lines of communication in a healthcare organization can be improved by appreciating and valuing each other's cultural perspectives, which balances strengths between the delegator and delegatee and improves client care outcomes. Considering all aspects of client care ensures that all of the client care needs are addressed. Selecting experienced nursing assistants as delegatees increases the chances of the delegatee to adapt to changing situations. Selecting a delegatee having similar strengths as that of the delegator may decrease the lines of communication because the delegatee might do the task of the delegator.

If a leader is using the simplest and fastest method of communication with his or her constituents, which of the five rules of the leader best describes this approach? Select all that apply. 1. maintain balance 2. manage time 3. listen to constituents 4. generate self-motivation 5. maintain a positive attitude

1, 2 rationale: Leaders must maintain balance and control over their lives. Good leaders use the simplest and fastest method of communication so as to be accessible and to manage their personal and professional time. Listening to constituents emphasizes that leaders must listen to their subordinates to determine whether action is necessary. The rule of generating self-motivation expresses the idea that leaders should not expect followers to be appreciative for the time spent on followers' needs and must generate enthusiasm by their own actions and attitudes. Maintaining a positive attitude involves using positive thinking and positive messages to create an environment in which followers believe in the organization, the leader, and themselves.

A nurse is caring for a client who belongs to a different cultural community. The client is not very fluent in the language that the nurse is communicating. What would the nurse say to the client to initiate appropriate communication? Select all that apply. 1. "Please tell me about the healthcare practices and beliefs of your community." 2. "Let me bring in an interpreter to help you understand the medical procedures better." 3. "I would like to know your personal beliefs regarding healthcare traditions and practices." 4. "Please let me explain our traditions and cultural practices to help you understand our healthcare practices." 5. "I have read up extensively about the healthcare practices of your community and have designed a care plan accordingly."

1, 2, 3 rationale: The nurse should try to understand the client's beliefs, traditions, and values and the effect of these dimensions on the client's healthcare beliefs and practices. If a language barrier exists, the nurse should engage the services of an interpreter to explain medical procedures. This action reduces the chances of accidental misinformation. The nurse should try to find out about the client's traditions, beliefs, and values in order to provide individualized care. The nurse should not discuss his or her personal beliefs with the client. The nurse should avoid stereotyping the client based on his or her culture by assuming that the client follows all the cultural practices of his or her community.

What would help facilitate communication and coordination during a mass casualty event in a hospital using the hospital incident command system? Select all that apply. 1. activate communication equipment 2. establish a command center in a designated location 3. provide key personnel with distinctive clothing identifying their role 4. ensure key personnel are properly immunized and have a personal emergency plan 5. distribute job action sheets identifying reporting relationships, tasks, and responsibilities

1, 2, 3, 5 rationale: To facilitate communication and coordination during a mass casualty event in a hospital using the hospital incidence command system, communication equipment needs to be activated. In addition, a command center needs to be created in a designated location. Key personnel need to be easily identified, which can be done by providing distinctive clothing which identifies their role. Jobs action sheets that identify reporting relationships, tasks, and responsibilities will also help facilitate communication and coordination at this time. Key personnel do not need to be immunized or have a personal emergency plan when handling a disaster within an organization.

What action should the nurse manager take when it becomes apparent that communication between the nurse and the client is consistently superficial? 1. Assessing the client's ability to understand the nurse's questions 2. Evaluating how actively the nurse has been listening to the client 3. Reinforcing to the client how important sharing is for successful recovery 4. Reviewing how the questioning techniques are being used by the client

2 rationale: Effective active listening is critical to the development of meaningful, therapeutic communication between the nurse and the client. A lack of effective listening on the part of the nurse commonly results in superficial, ineffective communication. Although there may be situations in which assessing the client's cognitive abilities, reinforcing the importance of effective communication, or reviewing communication skills is an appropriate intervention, there are other, more commonly observed barriers to effective therapeutic communication.

Which therapeutic communication technique involves using a coping strategy to help the nurse and client adjust to stress? 1. sharing hope 2. sharing humor 3. sharing empathy 4. sharing observations

2 rationale: Sharing humor is a therapeutic communication technique that involves using a coping strategy that adds perspective and helps the nurse and client adjust to stress. Nurses should recognize that hope is essential for healing and communicate a sense of possibility. Sharing empathy is the ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other. Sharing observations often helps a client to communicate without the need for extensive questioning, focusing, or clarification.

The registered nurse is teaching a nursing student about caring for a client who has difficulty speaking English. Which statement made by the nursing student would cause communication problems with the client? 1. i will give the client a call bell 2. i will involve the client's family members as interpreters 3. i will provide a dictionary to the client if the client can read 4. i will use boards and pictures to communication with the client

2 rationale: The nurse should not involve the client's family, especially children, as interpreters because they may misinterpret the client's feelings. The nurse should provide a call bell to the client to help the client ask for assistance. The nurse should provide a dictionary to the client if the client can read to help the client to easily interpret his or her feelings. The nurse should use communication boards and pictures aid in clear and effective communication with a client.

The nurse, as a leader, is planning to provide information about personal hygiene to a group of clients. Which communication methods should the nurse use to talk to the clients? Select all that apply. 1. giving abundant information 2. being sensitive to nonverbal communication 3. providing the opportunity for dialogue and feedback 4. presenting information that addresses the listener's self-interest 5. using primarily written methods, such as e-mail and text messages

2, 3, 4 rationale: The nurse should be sensitive to nonverbal communication because it may require interpretation of key points in complex situations. The nurse should provide the opportunity for dialogue and feedback. The nurse should present information that addresses the listener's self-interest. The nurse should plan the message and should not give too much information, which will paralyze the listener and divert energy away from key responsibilities. The nurse should use face-to-face communication as the primary communication mechanism rather than e-mail or texting.

A nurse leader wants to communicate and explain changes to hospital rules to team members. Which approaches should the nurse leader follow for effective communication? Select all that apply. 1. providing all the information related to the topic 2. explaining the reason behind the change 3. providing the opportunity for dialogue and feedback 4. using complex terms while addressing a diverse group 5. giving information that addresses the listener's self-interest

2, 3, 5 rationale: While communicating and explaining the rules of the hospital, listeners should be informed about the reason and values behind the changes. This may help them understand and reinforce the changes effectively. Opportunities for dialogue and feedback should be provided to analyze what was missed and which areas need improvement. Presenting the message in a manner that stimulates the self-interest of the listener may help in effective communication by better attracting the attention of the listener. The message for delivery should be strategically planned. Providing all or too much information can temporarily paralyze the listener and divert energy away from key responsibilities. The use of complex terms, concepts, or ideas may also prevent the learner from hearing the message and lead to ineffective communication.

The registered nurse (RN) is communicating with a healthcare team regarding the delegation of tasks. Which factors can determine the quality of communication between the RN and healthcare team? Select all that apply. 1. accuracy 2. effectiveness 3. responsiveness 4. meaningfulness 5. understandability

2, 4, 5 rationale: Effectiveness is a factor that determines the quality of the communication in delivering the appropriate information. The communication should be meaningful to improve the quality of the information. The communication should be understood by all the team members to perform a task properly. Accuracy of the assigned task can be known only after the result. Response to the communication reveals the ability of the healthcare team to understand the task.

A nurse leader is setting priorities for achieving success by using the simplest and fastest method of communication. Which rules and responsibilities does the nurse fulfill by this action? 1. maintaining balance 2. building self-confidence 3. generating self-motivation 4. maintaining a positive attitude

1 rationale: An effective leader maintains work-life balance in his or her own life, as well as facilitating balance for followers. Making communication as efficient as possible is one way of helping to maintain this balance. Self-confidence can be established by performing honest self-appraisal on a regular basis. Spending time on the needs of the followers and offering frequent and lavish praise will help build self-motivation. A positive attitude can be maintained by consistently having answers to the question asked by others, knowing where the organization is going, and taking the initiative to get the group to its goal.

To help establish a therapeutic nurse-client relationship, the mental health nurse uses various communication techniques to convey a willingness to listen and a genuine desire to view the client and his or her needs in a respectful manner. What is the primary underlying principle guiding this process? 1. Caring is the underlying component of nursing that promotes client care. 2. Understanding of the psychosocial effects of a specific mental illness is vital to client care. 3. Each client has a right to appropriate care directed toward both the client's strengths and weaknesses. 4. The nurse initiates and maintains the nurse-client relationship so as to be therapeutic in its nature.

1 rationale: Caring is the essential component of nursing that promotes the therapeutic relationship and ultimate growth of the nurse-client relationship and the development of client care that is respectful and genuine in its caring. Although understanding the psychosocial effects of a specific mental illness, directing appropriate care toward the client's strengths and weaknesses, and initiating and maintaining the nurse-client relationship contribute to the nurse-client relationship, they are not statements of the primary principle that serves as the basis of this process.

How can a nurse best evaluate the effectiveness of communication with a client? 1. client feedback 2. medical assessments 3. health care team conferences 4. client's physiologic responses

1 rationale: Feedback permits the client to ask questions and express feelings and allows the nurse to verify client understanding. Medical assessments do not always include nurse-client relationships. Team conferences are subject to all members' evaluations of a client's status. Nurse-client communication should be evaluated by the client's verbal and behavioral responses.

Which therapeutic communication technique is useful when the nurse and a client have a conversation and the client begins to repeat the conversation to himself or herself? 1. focusing 2. clarifying 3. paraphrasing 4. summarizing

1 rationale: Focusing is a therapeutic communication technique that is useful when clients begin to repeat themselves. Clarification helps to check whether the client's understanding is accurate by restating an unclear or ambiguous message. Paraphrasing involves restating a message more briefly using one's own words. Summarizing is a concise review of key aspects of an interaction.

Spanish is being cared for at a hospital in which nursing personnel only speak English. What communication technique would be appropriate for the nurse to use when discussing healthcare decisions with the client? 1. Contact an interpreter provided by the hospital. 2. Contact the client's family member to translate for the client. 3. Communicate with the client using Spanish phrases the nurse learned in a college course. 4. Communicate with the client with the use of a hospital-approved Spanish dictionary.

1 rationale: Interpreters provided by the healthcare organization should be used to communicate with clients with limited English proficiency to ensure accuracy of communicated information. In hospital settings, it is not suitable for family members to translate healthcare information, but they can assist with ongoing interactions during the client's care. The other options do not ensure accurate interpretation of language.

The goal of a particular nursing theory is to use communication to help a client re-establish positive adaptation to environment, and the framework for the nursing practice is based on treating nursing as a dynamic interpersonal process among the nurse, the client, and the healthcare system. Which nursing theory are these points related to? 1. king's theory 2. neuman's theory 3. nightingale's theory 4. benner and wrubel's theory

1 rationale: King's theory focuses on using communication to help the client re-establish positive adaptation to the environment; its framework for practice is based on treating nursing as a dynamic interpersonal process among the nurse, the client, and the healthcare system. Neuman's theory focuses on helping individuals, families, and groups attain and maintain a maximum level of total wellness by purposeful interventions. Nightingale's theory is based on facilitating the reparative processes of the body by manipulating a client's environment. Benner and Wrubel's theory focuses on a client's need for caring as a means of coping with stressors of illness.

A staff nurse states "I am sorry, I am responsible for the situation" while communicating to the nurse leader. Which communication pattern is the staff nurse using? 1. placation 2. irrelevant 3. congruence 4. attribution of blame

1 rationale: Placation means to appease. By saying "I am sorry, I am responsible for the situation," the staff nurse is taking the blame. An irrelevant pattern is used when someone is trying avoid a situation or ignore his or her feelings. Congruence is used when matching inner feelings with words. While blaming others for any situation, attribution of blame is applied.

A client with laryngeal cancer has a partial laryngectomy and tracheostomy. To best facilitate communication postoperatively, what should the nurse do? 1. provide a means for the client to write 2. allow the client more time for articulation 3. use visual clues, such as gestures and objects 4. face the client and speak slowly and distinctly

1 rationale: The client needs a means to write. The client will be unable to speak because a tracheostomy tube is in place to prevent edema. The client cannot speak with a tracheostomy tube in place. The client's ability to see and hear is not affected. The client can receive information but cannot speak. The client's ability to hear or understand is not affected.

A nurse understands that value clarification is a technique useful in therapeutic communication because initially it helps clients do what? 1. become aware of their personal values 2. gain information related to their needs 3. make correct decisions related to their health 4. alter their value systems to make them socially acceptable

1 rationale: Value clarification is a technique that reveals individuals' values so the individuals become more aware of them and their effect on others. Gaining information, making correct health decisions, and altering value systems to make them more socially acceptable are not outcomes of value clarification.

The registered nurse (RN) assigned a task to the licensed practical nurse (LPN) to monitor the vital signs of the client. The LPN monitored and reported the information to the RN. Which characteristic of communication may interfere in this delegation process? 1. information decay 2. information quality 3. information salience 4. information of mutual trust

1 rationale: When the information is not properly reported and when there is a chance of missing information, then the characteristic of communication is information decay. When the information is reported with quality and clarity then the characteristic of communication in the delegation process is information salience. Information quality is giving the right message in a timely manner. Mutual trust improves the effectiveness of delegation.

A nurse considers that communication links people with their surroundings. What should the nurse identify as the most important communication link? 1. social 2. physical 3. materialistic 4. environmental

1 rationale: Without some form of communication, there can be no socialization. People interact with other social beings, not with inanimate objects. Physical, materialistic, and environmental surroundings are all inanimate and cannot interact.

The nurse with limited clinical experience is preparing a delegation communication template. Which action by the nurse indicates the need for correction? 1. identifying the priorities 2. specifying the performance limitations 3. emphasizing what may not be delegated 4. specifying that no extra time is allotted to report data

4 rationale: A delegation communication template is used for the delegation of tasks. It is beneficial to provide greater positive outcomes within specified dates. The template should contain the report time frames and when data is expected. It should specify deadlines, including the allowable deviations and exact timelines. Identifying priorities aids in overcoming challenging and overwhelming situations. Specifying the performance limitations aids in tracking and managing the task updates. It is important to make the delegatee understand what is to be delegated and what is not to be discussed to produce expected data.

A client is placed on a restricted diet. What is the best communication technique for the nurse to use when beginning to teach the client about the diet? 1. Asking about what type of foods the client usually eats 2. Telling the client that the diet must be followed exactly as written 3. Telling the client that the intake of foods on the list must be limited 4. Asking about what the client knows about the diet that was prescribed

4 rationale: Asking about what the client knows about the prescribed diet may validate the client's understanding; the response may indicate the need for further teaching or that the client understands; understanding and accepting the need for restrictions will increase adherence to the diet. Assessing the client's food preferences and teaching about diets follow an assessment of the client's understanding about the need for a specific diet; the client must understand the need for and the benefits of the diet before there is a readiness for learning. Telling the client that the diet must be followed exactly as written and telling the client that the intake of foods on the list must be limited are authoritarian and should be avoided.

A nurse uses therapeutic communication techniques in order to achieve desired client outcomes. Which communication technique is a part of therapeutic communication? 1. asking for explanations 2. showing sympathy to the client 3. asking personal questions of the client 4. providing relevant information to the client

4 rationale: Because clients have the right to know about their health status, the nurse should provide them with all relevant information. This is a therapeutic communication technique that enables clients to understand what is happening and what to expect. Asking for explanations, showing sympathy and asking personal questions of the client are nontherapeutic communication techniques.

Which outcome specific to a client with impaired verbal communication related to a psychologic barrier should be documented in the client's clinical record? 1. freedom from injury 2. engaging independently in solitary craft activities 3. identifying the consequences of acting-out behavior 4. interacting appropriately with others in the therapeutic milieu

4 rationale: Interacting appropriately with others in the therapeutic milieu is an outcome related to the identified problem and is appropriate and measurable. Freedom from injury is not related to the identified problem; this is true for everyone. Engaging independently in solitary craft activities will not encourage verbal communication. Identifying the consequences of acting-out behavior is inappropriate and not related to the identified problem.

What is a goal for a client who has difficulty with verbal communication precipitated by psychologic barriers? 1. the client will be free of injury 2. the client will demonstrate decreased acting-out behaviors 3. the client will identify consequences of acting-out behavior 4. the client will interact with other people in the environment

4 rationale: Interacting with other people in the environment is appropriate and measurable. Being free of injury is not related to the client's problem; the priority for this client is to facilitate interaction with others. Acting-out behavior is not inherent in the situation.

A case manager telephones a client with lung disease to evaluate respiratory function with home oxygen use and then contacts the primary care provider. What is the purpose of this communication? 1. collect data 2. plan activities 3. validate interventions 4. evaluate expected outcomes

4 rationale: It is essential that the case manager have frequent interaction with the client and the healthcare provider to achieve and evaluate expected outcomes. The nurse is not phoning the client and care provider to collect data, plan activities, or validate interventions.

The registered nurse is evaluating the statements made by a student nurse after teaching about the delegation communication template. Which statement made by the student nurse indicates a need for correction? 1. "The delegation communication template should identify the priorities." 2. "The delegation communication template should specify the deviations." 3. "The delegation communication template should identify the appropriate resources." 4. "The delegation communication template should include only the work that is to be delegated."

4 rationale: The delegation communication template should emphasize the work that is not to be delegated. The delegation communication template should identify the priorities such as what is to be done first. The delegation communication template should specify deviations such as when to take an immediate action. The delegation communication template should identify the appropriate resources including the individual consultants.

When a bedridden client complains that he or she is thirsty, the nurse leader says, "I want to make you comfortable. Here is a glass of water, please take it." Which communication skill is the nurse leader using to make caring visible? 1. listening actively 2. expressing appreciation 3. showing caring non-verbally 4. making explicit her or his positive intent

4 rationale: The nurse is making explicit her or his positive intent by explaining the purpose and by showing what he or she is doing in the client's best interest. Listening actively indicates acknowledging and reflecting back the person's feelings in a nonjudgmental way. Expressing appreciation refers to giving the personal gift of positive reward. Showing caring nonverbally can be done by using a facial expression, intonation, posture, eye contact, and body language to mirror the client's feelings.

Which initiative demonstrated by the registered nurse is an effective art of communication of a leader? 1. keeping the information broad 2. ignoring the loss involved in the change 3. being sensitive to verbal communication 4. reinforcing the values behind the change

4 rationale: To be an effective leader, the nurse should reinforce the values behind the change by explaining why something has changed. To be an effective leader, the nurse should keep the information simple. To be an effective leader, the nurse should acknowledge the loss involved in the process of change. To be an effective leader, the nurse should be sensitive to nonverbal communication.