Fundamentals Ch. 8 Communication
Which nursing actions would most likely help improve communication with clients and achieve a more effective helping relationship? Select all that apply. The nurse never admits a lack of knowledge to the client to avoid undermining the client's confidence in the helping relationship. The nurse makes statements that are as simple as possible, gearing conversation to the client's level. The nurse remains focused on the topic at hand and does not allow the client to diverge to another topic. The nurse feels free to use words that might have different interpretations when using the same language as the client. The nurse controls the tone of voice so that it conveys exactly what is meant. The nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations.
The nurse makes statements that are as simple as possible, gearing conversation to the client's level. The nurse controls the tone of voice so that it conveys exactly what is meant. The nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations.
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: ask the child's parents to leave the room while the nurse and child talk. provide both verbal and written information to the child. involve the child's stuffed animal in the educational session. show the child the intravenous catheter and explain how it works.
involve the child's stuffed animal in the educational session.
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?" "Does it hurt when I touch you here?" "What sorts of things do you do for fun?" "Is there any chance you might be pregnant?" "What plans do you have after you are discharged?"
"Are you ready to get out of bed?" "Do you smoke cigarettes?" "Does it hurt when I touch you here?" "Is there any chance you might be pregnant?"
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic? "My grandfather also benefited from laser surgery." "You should try laser surgery." "Why don't you try laser surgery?" "Have you ever thought of laser surgery?"
"Have you ever thought of laser surgery?"
A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication? "I think there is a better way to handle this." "Why are you treating me this way?" "You always act like this." "What is your problem with me?"
"I think there is a better way to handle this."
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. Consult the oncology nurse specialist. Talk with the client's children to determine needs. Use a text-telephone device (TTD) for daily communication.
Arrange for a sign language interpreter when discussing treatment.
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive? Hand gestures Eye contact Facial expressions Posture
Eye contact
The nurse makes a contract with the client during which phase of the nurse-client relationship? Orientation phase Working phase Intimate phase Termination phase
Orientation phase
The nurse is reporting to an oncoming nurse about the care of a client using the SBAR format. The nurse informs the oncoming nurse that the client should continue to have neurological checks every 2 hours and the nurse should report any alterations to the health care provider. In which section should this information be relayed? Background Situation Assessment Recommendation
Recommendation
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 client's family The nurse from the oncoming shift The unit's mental health technicians The client's closest friend
The client's physician The nurse from the oncoming shift The unit's mental health technicians
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: ask the client for a urine specimen for urine drug use screening. remain honest, open, and frank. consult with the social worker regarding inpatient drug rehabilitation. ask if the client realizes the infection is a direct result of the drug use.
remain honest, open, and frank.
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: target. decoder. receiver. sender.
sender.
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? Sympathy Humility Empathy Curiosity
Empathy
Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached? Kindness Commiseration Sympathy Empathy
Empathy
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive? Hand gestures Eye contact Facial expressions Posture
Facial expressions
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: assertive. aggressive. nurturing. passive.
aggressive.
In the provision of care and the establishment of the therapeutic relationship, the nurse must first: avoid labeling clients. understand the client's response. be aware of one's own personality. treat the client with dignity.
be aware of one's own personality.
Each of the following facilitates a therapeutic nurse-client relationship except: closed-ended questions. reflection. active listening. rephrasing.
closed-ended questions.
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. pallor and diaphoresis. cold intolerance and brittle nails. slow heart rate and prolonged capillary refill.
easy wrinkling of the skin and sunken eyes.
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 Reassuring the client that back surgery will likely alleviate the pain completely Explaining in detail all of the pain management options available Sharing the nurse's own family and personal history of back pain
Being sensitive to the client's emotional barriers
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 termination phase The orientation phase The introduction phase The working phase
The working phase
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?" "I see you have been crying. Do you want me to call someone for you?" "Don't worry, I have seen lots of people with cancer do fine." "I am sorry to hear you have cancer. I would be upset too, is there anything I can do?"
"I see you are upset. Would you like to talk?"
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 Intrapersonal Small-group Organizational
Interpersonal
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? Have the interpreter write out all of the information listed in the unit brochure. Ensure that family members are present. Give all of the discharge instructions at once. Speak directly to the client.
Speak directly to the client.
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: tell the client to rest and allow a family member to answer. ask questions as quickly as possible. use only open-ended questions. allow the client to set the pace.
allow the client to set the pace.
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? "Was there any cracking of the windshield?" "Were there any fatalities in the other vehicle?" "All of the people got themselves out of the car?" "Did a police officer take a report at the accident scene?"
"All of the people got themselves out of the car?"
The nurse is performing an admission interview with a new client diagnosed with acute coronary syndrome. For the nurse to obtain information and allow the client free verbalization, which question would elicit the most information? "Could you tell me more about how you are feeling right now?" "Have you ever had chest pain prior to this admission?" "I have had chest pain before, and it is really scary!" "Did you take any medication when you had the pain?"
"Could you tell me more about how you are feeling right now?"
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? "Close your eyes and take a deep breath. I know you were frightened, but the baby is healthy and everything is going to be okay." "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." "I can help you, please talk to me so that I know how I can help you." "This is great news. You don't have anything to worry about and the baby is doing well."
"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."
Which is a skill appropriate to use in therapeutic communication? Avoid the use of periods of silence. Be precise and inflexible regarding the intent of the conversation. Use cliches to enhance a client's understanding of information. Control the tone of the voice to avoid hidden messages.
Control the tone of the voice to avoid hidden messages.
The nurse cares for a client who is sharing a personal health story. Which behavior(s) demonstrates active listening? Select all that apply. The nurse paraphrases what the client has stated before generating a response. The nurse observes the nonverbal behavior of the client as the client speaks. The nurse shares a personal story about experiences with hospitalization. The nurse makes eye contact while the client is sharing a personal story. The nurse offers multiple solutions while the client is sharing a personal story.
The nurse paraphrases what the client has stated before generating a response. The nurse observes the nonverbal behavior of the client as the client speaks. The nurse makes eye contact while the client is sharing a personal story.
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? "Sitting in the dark is not going to cure your cancer. Let's open the curtains." "Can you please tell me why you are crying?" "I am so sorry you are going through this. Can we talk?" "I know this is hard for you. Is there any way I can help?"
"I know this is hard for you. Is there any way I can help?"
A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment? Direct the client in the other bed to walk in the hallway. Ask all visitors to leave the room. Pull the curtain dividing the two beds. Bring the client into the hallway to discuss the treatment plan.
Pull the curtain dividing the two beds.
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." "That's a lot of information to take in. Would you like to talk about it?" "Everything will be all right." "Don't worry. You will be just fine in another day or two."
"Cheer up. Tomorrow is another day." "Your doctor knows best." "Everything will be all right." "Don't worry. You will be just fine in another day or two."
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? "Were these term births?" "How old are your children?" "All right, you have four children, is that correct?" "I understand you have four kids; how many times have you actually been pregnant?"
"I understand you have four kids; how many times have you actually been pregnant?"
A client comes into the urgent care center to have sutures removed on an arm. The nurse finds significant crusting along the suture line. The client states not having time to get the sutures removed a week prior, as directed. The nurse soaks the crust and attempts to remove the sutures. As the nurse attempts the suture removal, the client frequently pulls the arm away and tells the nurse, "You are taking too long and it is hurting a little bit. Just pull them out and get it over with." Which statement is an example of appropriate therapeutic response? "I am sorry it is taking so long and I am hurting you; next time do not wait too long to get sutures removed or the same thing will happen" "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." "It will not hurt if you relax and stop pulling your arm away." "I am sorry it is taking so long. Tell me how you hurt your arm?"
"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."
A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client? "The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." "The procedure may take only 2 minutes, so you might get through it by mentally counting up to 120." "I will be by your side throughout the procedure; the procedure will be painless if you don't move." "You may feel very uncomfortable when the needle goes in, but you should breathe rhythmically."
"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position."
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? "Are you in a hospital?" "Is your name Evelyn?" "Is today the first day of the month?" "What day of the week is it?"
"What day of the week is it?"
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?" "Are you allergic to any medications?" "Can you tell me the medications you take on a daily basis?" "Do you have an advanced directive or a living will?"
"What did your health care provider tell you about your need to be admitted?"
Which is an open-ended question? "Do you take this medication daily?" "Why did the health care provider prescribe this medication for you?" "How many tablets do you take at one time?" "When was the last time you had your prescription refilled?"
"Why did the health care provider prescribe this medication for you?"
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." "I understand your confused, what do you think you should do?" "I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?" "You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure."
"You seem unsure. Tell me your concerns about your surgery."
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? "Don't worry about labor, I have been through it and it is not so bad." "I would recommend keeping a positive attitude." "You're worried about how you will tolerate the pain associated with labor." "There are many good medications to decrease the pain; it will not be so bad."
"You're worried about how you will tolerate the pain associated with labor."
What nursing care behavior by the nurse engenders a client to trust the nurse? A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. A nurse tells the client, "Do not worry about the test, I have never cared for anyone that had problems with it." A nurse tells the client, "My shift will be over in 45 minutes, I will let the oncoming nurse know you have questions about tomorrow's test." A nurse answers the client's questions about an upcoming test while completing documentation in the EHR.
A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client.
In which situation would the SBAR technique of communication be most appropriate? A nurse is facilitating a family meeting to coordinate a client's discharge planning. A nurse is explaining the process of bone marrow biopsy to a client who is scheduled for the procedure. A nurse is teaching a client about the benefits of smoking cessation and the risks of continuing to smoke. A nurse is calling a physician to report a client's new onset of chest pain.
A nurse is calling a physician to report a client's new onset of chest pain.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse? A nurse describes a client on Twitter by giving the client's diagnosis rather than the client's name. A nurse posts pictures of a client who accomplished a goal of losing 100 lb and later deletes the photo. 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 nurse describes a client on Twitter by giving the room number rather than the name of the client.
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client? Approach the client with empathy and understanding and allow the client to share feelings without being judged. Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive. Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding. Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation.
Approach the client with empathy and understanding and allow the client to share feelings without being judged.
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 Aggressive Therapeutic Nonassertive
Assertive
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? Contact a person skilled in sign language Assess how the client would like to communicate Provide paper and pencil for written communication Use facial and hand gestures
Assess how the client would like to communicate
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? Smile and say, "Don't worry, I am sure the physician is doing a good job." Be silent and allow the client to continue speaking when ready. Nod and say, "I agree. If I were you, I would get a new doctor." Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
Be silent and allow the client to continue speaking when ready.
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. Allow the client's child to interpret. Ask a fellow nurse who knows some words in the client's language to help. Involve a friend who speaks both the dominant and the client's languages.
Contact a professional interpreter.
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? Sympathy Empathy Pity Indifference
Empathy
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? Evaluation phase Orientation phase Working phase Termination phase
Orientation phase
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 looks at the nurse and states, "I am still not feeling my best." The client stares at the floor and states, "I feel fine." The client smiles at the nurse and states, "I cannot wait to go home." The client is sitting in a chair and states, "I feel a lot better than I did yesterday.
The client stares at the floor and states, "I feel fine."
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. The nurse asks the client if he or she is worried about giving oneself an injection. The nurse stops the instruction and tells the client that a call will be placed to the health care provider to get an order to have a home health nurse administer the medication. The nurse continues with the instructions and makes a mental note to repeat the initial instructions at the end of the training.
The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe.
A nurse is communicating the plan of care for a client who is unconscious. Which nursing actions best facilitate this process? Select all that apply. The nurse speaks with the client before touching the client. The nurse assumes the client can hear and discusses things that would ordinarily be discussed. The nurse raises environmental noises to help stimulate the client. The nurse is careful what is said in the client's presence because hearing is the last sense to go. The nurse speaks to the client in a louder-than-normal voice. The nurse does not use touch to communicate with the client.
The nurse speaks with the client before touching the client. The nurse assumes the client can hear and discusses things that would ordinarily be discussed. The nurse is careful what is said in the client's presence because hearing is the last sense to go.
When collecting data on a client, the nurse implements which nonverbal communication form as one of the most effective to express feelings? Gait Body posture Eye contact Touch
Touch
A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult: a clinical psychologist. an ophthalmologist. an audiologist. an optometrist.
an audiologist.
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: return to the nurse's home unit and ask to meet with the charge nurse. call the nursing supervisor to address the situation at hand. ask to speak to the physician in private and address the disrespectful remark. write a written account of what transpired and contact an attorney.
ask to speak to the physician in private and address the disrespectful remark.
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? asking the client's family to discuss the importance of the prescribed treatment with the client explaining the health consequences of refusing to undergo the prescribed treatment recommending assessment of the client's cognitive capacity to make health care decisions contacting the interprofessional care team to discuss alternative treatment options
contacting the interprofessional care team to discuss alternative treatment options
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should: ask all visitors to leave the room. ask the client's partner to leave the room to allow the client to focus. ask the client if she is able to read. eliminate as many distractions as possible.
eliminate as many distractions as possible.
The nurse is beginning an assessment on a nonverbal client. The nurse must first: use various forms of communication when interacting with the client. verbalize all steps of the nursing assessment when interacting with the client. establish eye contact prior to assessing, touching, and interacting with the client. speak loudly when interacting with the client.
establish eye contact prior to assessing, touching, and interacting with the client.
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: pick a team leader who is not the dominant member. have group members issue a written warning to the dominant member. plan a meeting where the dominant person cannot attend. have group members confront the dominant member to promote the needed team work.
have group members confront the dominant member to promote the needed team work.
When communicating with clients, nurses need to be very careful in their approach. This is particularly true when communicating using: audio-visual material. demonstration. medical terminology. written material.
medical terminology.
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: staring into the neonate's eyes and smiling. swaddling the child and gently stroking its head. softly humming a song near the neonate. offering the neonate infant formula.
swaddling the child and gently stroking its head.
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: inform the client that several nurses will be needed to care for this wound. ask the charge nurse to change the assignment. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. tell the unlicensed assistive personnel (UAP) to gather supplies and to prepare to cleanse and dress the wound.
tell oneself to "remain calm" and remember that the nurse was trained to perform this skill.
