Therapeutics final

The nurse cares for a patient with a terminal illness. Which way would be the most therapeutic for the nurse to communicate with this patient? A. Use an honest, judgmental attitude. B. Demonstrate understanding with empathy. C. Acknowledge hope by expressions of sympathy. D. Consistently evaluate the patient's feelings.

Demonstrate understanding with empathy.

A nurse manager asks a colleague for advice on strategies to improve communication with staff nurses. Which response by the nurse manager's colleague is best? A. "Be sensitive, show respect, and be genuine." B. "You need to be consistently nice to the staff nurses." C. "Work as a staff nurse every month to develop empathy." D. "Staff nurses need a leader who is not emotional."

"Be sensitive, show respect, and be genuine."

Which statement, if made by the nurse, could positively affect the course of the patient's situation by suggestibility? A. "Breastfeeding will provide time to bond with your baby." B. "Breastfeeding will take longer than giving your baby a bottle." C. "You will need to be careful about taking medications while breastfeeding." D. "Breastfeeding mothers can develop infections that are serious."

"Breastfeeding will provide time to bond with your baby." The placebo effect is language or expectations of a nurse that positively affect the course of the patient's illness by suggestibility, and the nurse is sending a positive message (e.g., increased time for bonding). When considering bottle preparation, storage, and cleanup, it is inaccurate to say that breastfeeding will take more time. The nocebo effect can occur when a nurse sends a negative message through choice of language, words, or tone of voice that produces negative responses (e.g., breastfeeding takes time, limits medication options, and causes infections).

A nurse educator teaches nursing students about professional communication. Which statement, if made by a nursing student, indicates an understanding of the instructions? a. "If a situation is urgent, the nurse does not focus on communication skills." b. "Nurses in expanded roles can rely on communication skills learned in nursing school." c. "Once communication skills are learned, nurses do not need additional education." d. "Communication requires a commitment to grow, to change, and to be connected."

"Communication requires a commitment to grow, to change, and to be connected."

A nurse manager offers a staff nurse a choice between working 8- or 12-hour shifts. Which statement, if made by the staff nurse, is nonassertive and may result in a frustrated response from the nurse manager? A. "I want to decide the shifts for all of the other staff nurses." B. "Do whatever you want. It doesn't really matter to me." C. "Thank you for offering me a choice. I prefer 12-hour shifts." D. "You will never be able to give me what I really want to work."

"Do whatever you want. It doesn't really matter to me."

Which three nurse statements are examples of expressing opinions in an assertive way with colleagues? (Select all that apply) A. "Do you think this project will help you learn about evidence-based practice?" B. "I will tell you about the evidence-based project, and you will want to help." C. "I recently attended an evidence-based conference. Can I share the highlights?" D. "I think we should be paid because this project will save money. What do you think?" E. "I really think you should read more evidence-based journal articles."

"Do you think this project will help you learn about evidence-based practice?" "I recently attended an evidence-based conference. Can I share the highlights?" "I think we should be paid because this project will save money. What do you think?" To avoid generating feelings of hostility or resentment, the nurse should ask colleagues if they are interested in hearing the nurse's viewpoint. The nurse should avoid being dogmatic or using strong phrases when expressing opinions. The nurse should be tentative about offering persuasions to show consideration of others' special circumstances. When offering an opinion, the nurse should give others a fair chance to accept or reject ideas. When expressing opinions to colleagues, the nurse should give the rationale in a responsible way; the nurse should offer a reason for his or her preferences and then turn the final decision back to the client.

The nurse observes a student nurse who demonstrates nonverbal expressions that are cold and convey disinterest when caring for patients. Which statement, if made by the nurse, is best? A. "Patients will complain about you because your behaviors are unprofessional." B. "Have you noticed that your patients do not like you very much?" C. "For the next few shifts, closely observe how I display warmth to patients." D. "You need to change your behavior when interacting with your patients."

"For the next few shifts, closely observe how I display warmth to patients." The nurse should recommend an exercise that will help the student nurse identify nonverbal behaviors that convey warmth before the student nurse observes or changes his or her own behaviors. The term "unprofessional" indicates conduct, behavior, or language that is not befitting to a profession. The nurse should help the student nurse to recognize nonverbal behaviors that convey warmth instead of focusing on consequences (i.e., patient complaints) or likeability. Telling the student nurse to change behavior is not helpful; the nurse should initially focus on helping the student to identify behaviors that display warmth.

A nurse manager has set a goal to improve professional communication on the unit. The staff nurses have attended a session on how to distinguish between expressing opinions and giving advice. Which statement, if made by a staff nurse, indicates that further teaching is needed? A. "Nurses who express opinions give patients the opportunity to make choices." B. "Patient safety is enhanced if nurses have confidence in their ability to communicate." C. "Giving advice leads to independent decision making by patients." D. "Expressing opinions or recommendations is an assertive behavior."

"Giving advice leads to independent decision making by patients." Giving advice is a unilateral process of solving problems or making decisions for others; giving advice prevents patients from becoming independent. Assertive communication occurs when nurses express opinions or offer recommendations. Expressing opinions assists patients in their decision making and fosters independence. Having confidence in the ability to communicate can help prevent miscommunication, a significant threat to the safety of hospitalized patients.

A family member of a patient with a terminal disease asks the nurse to explain the difference between hospice and palliative care. Which is the best response by the nurse? a. "A patient must have less than 6 months to live to qualify for palliative care." b. "Hospice provides support for the patient and family during the dying process." c. "There is no difference between hospice care and palliative care." d. "Palliative care provides financial support for patients at the end of life."

"Hospice provides support for the patient and family during the dying process."

The nurse notices that a recently hired licensedpractical/vocational nurse (LPN/LVN) is reluctant to care for dying patients. Which is the most important questions for the nurse to ask? a. "How do you feel about caring for a dying patient?" b. "Do you want to continue working on this unit?" c. "What patient assignment do you want today?" d. "Have you lost someone you are close to lately?"

"How do you feel about caring for a dying patient?"

The nurse instructs the nursing assistant to obtain temperatures on four patients and report abnormal findings immediately. Two hours later the nurse discovers that one of the patients had a fever that was not reported. The nurse is upset with the nursing assistant. Which statement, if made by the nurse, is concrete and specifically explains the nurse's feelings? A. "I am not dissatisfied with your performance, because we all make mistakes." B. "You must have misunderstood. I wanted to know about any elevated temperatures." C. "I am disappointed because you did not follow my directions." D. "You have made me so angry. Why did you not report the fever to me?"

"I am disappointed because you did not follow my directions." When communicating feelings clearly and specifically, the individual must choose the descriptor that exactly conveys the intended emotion. Adding a rationale for the feeling enhances the sincerity of the message. If the emotion is one of feeling upset, the term "disappointed" is clear and specific. The descriptor "not dissatisfied" is the opposite of the feeling of "upset." The descriptor "angry" is a much stronger feeling than "upset." The statement "you must have misunderstood" does not convey the nurse's feelings about the situation.

The nurse manager asks the staff nurse to work an extra shift. Which response by the staff nurse is assertive and based on rational beliefs? A. "I don't want you upset, so I will work extra." B. "Why do I always have to cover extra shifts?" C. "I am not able to work an extra shift." D. "If you can't find anyone else, I will do it."

"I am not able to work an extra shift."

A patient asks the nurse to make a decision for her about whether or not to continue taking hormone replacement therapy (estrogen). Which response by the nurse is most appropriate? A. "You should check with a doctor; I cannot give you advice about drugs." B. "My friend has taken estrogen for more than 5 years without any problems." C. "I can answer any questions you have but it is up to you to make this decision." D. "Herbal supplements were much better for me than prescription-strength estrogen."

"I can answer any questions you have but it is up to you to make this decision." Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. Dependency is a situation in which immediacy is appropriate in the nurse- client relationship. If the patient is unable to make a decision and wants advice from the nurse, the nurse should acknowledge the dependency and state that information can be provided, but the decision needs to be made by the patient. It is within the scope of practice of a nurse to provide information about medications. The nurse should not disclose personal information or experiences in situations of dependency.

The nurse cares for a client with abdominal pain who is scheduled for exploratory surgery. Which statement(s), if made by the nurse, indicates that the client's rights in the helping relationship have been violated? (Select all that apply) A. "I do not have time right now to help you call your family." B. "I am available to answer questions that you may have about your surgery." C. "You seem frightened. I will stay with you until your family arrives." D. "Your neighbors called, and I told them that you will have surgery." E. "If you do not let me start your IV, I will not give you pain medication."

"I do not have time right now to help you call your family." "Your neighbors called, and I told them that you will have surgery." "If you do not let me start your IV, I will not give you pain medication."

A new blood glucose bedside monitoring system is introduced at a staff meeting. A nurse who has previously used this system remembers that the meter would show error messages frequently. Which statement by the nurse demonstrates assertiveness? A. "Why did no one ask for my opinion? I should have been involved in this decision." B. "This meter does not work like it should, and I refuse to use this system ever again." C. "I had problems with this meter before, but I will use it and let you know what I think." D. "I have experience with this system, and there were never any serious problems."

"I had problems with this meter before, but I will use it and let you know what I think." Nurses may feel powerless if decisions are made without their input or with which they disagree. Nurses can make a choice about when to share their disagreement even if they see no choice but to comply with the decision. Voicing disagreement makes the nurse feel more authentic and assertive. Assertiveness is a matter of choice and is not necessary or appropriate in every situation.

The nurse manager teaches a group of graduate nurses how to respond to angry colleagues effectively. Which statement, if made by a graduate nurse, indicates a need for further instruction? a. "It is important to consider your colleague's point of view." b. "Anger may be caused by frustration or fear of loss of control." c. "I should avoid interactions with angry colleagues." d. "I may feel uncomfortable when dealing with an angry colleague."

"I should avoid interactions with angry colleagues."

The charge nurse informs a staff nurse that it is her turn to float to another unit. Which response by the staff nurse is aggressive? A. "I had such a bad experience last time. Please send another nurse instead of me." B. "I will miss working with you today, but I understand that it is my turn to float." C. "I will not survive on the other unit. The staff are always too busy to help me." D. "I will float, but you'll be sorry. You cannot handle emergencies without me."

"I will float, but you'll be sorry. You cannot handle emergencies without me."

The nurse provides information to a daughter about what to expect as her father nears death. Which statement, if made by the daughter, indicates further teaching is required? a. "It is normal for my father to sleep more often." b. "I will make sure my father drinks enough fluids." c. "My father's breathing may stop and start again." d. "I should continue to talk to my father and hold his hand."

"I will make sure my father drinks enough fluids."

The nurse cares for a patient who is hospitalized on the 1-year anniversary of the death of her husband. Which statement, if made by the nurse, is most appropriate? a. "I will turn on the television and help you find a favorite program." b. "I am sure your husband would want you to be happy and not sad." c. "It is OK to talk to your husband and reflect on how he would respond." d. "Focus on getting better, and don't think about your husband today."

"It is OK to talk to your husband and reflect on how he would respond."

The nurse cares for a patient who has type 2 diabetes mellitus and does not consistently follow the dietary restrictions and exercise recommendations. The patient takes a daily oral hypoglycemic agent as prescribed. Which statement by the nurse is most appropriate? A. "It is great that you take your medicine as prescribed." B. "It wouldn't be that hard to walk a few blocks every other day." C. "You are definitely not one of my good patients." D. "It is a waste of time to help you because you will never change."

"It is great that you take your medicine as prescribed."

The nursing supervisor instructs a group of novice nurses about the appropriate use of self-disclosure with patients. The nursing supervisor determines that teaching was successful if the novice nurse makes which statement? A. "Self-disclosure provides an opportunity for the patient to understand the nurse." B. "It is better to disclose stories about others to maintain professional boundaries." C. "Self-disclosure may be used to build a trusting relationship with the patient." D. "A fabricated personal experience can be shared if the patient remains the main focus."

"Self-disclosure may be used to build a trusting relationship with the patient." Self-disclosure is used to help the nurse understand the patient better; the goal is not to help the client understand the nurse better. Self-disclosure should be used only if the experience is similar and the experience actually happened.

A family member of a critically ill patient is irritated and upset. Which statement, if made by the nurse, would be most appropriate? a. "Why are you feeling upset?" b. "You should not feel so upset." c. "What have I done to make you upset?' d. "Tell me what is upsetting you today."

"Tell me what is upsetting you today."

The nurse plans to delegate a client's personal hygiene to a nursing assistant. Which statement if made by the nurse to the nursing assistant is assertive? A. "Would you mind helping the client with a bath when you have time? If not, I will skip my lunch and do it myself." B. "You never get your work done and are always on the phone. You need to help the client right now with a bath, or I will write you up." C. "The client needs help with bathing. I want you to assist the client now, and you can go to lunch when you are finished." D. "I have important work to complete this morning. You will assist the client with a bath. Do not take a break until you have finished."

"The client needs help with bathing. I want you to assist the client now, and you can go to lunch when you are finished."

1. Which statement describes the effective aspect of learning effective communication strategies? A. "The nurse should use clear, direct statements using objective words." B. "The nurse uses body language that is congruent with the verbal message." C. "The nurse believes that positive communication strategies build confidence." D. "The nurse practices assertive and responsible communication strategies."

"The nurse believes that positive communication strategies build confidence."

The nurse plans to confront a visitor who brings candy to a patient with diabetes. Which statement, if made by the nurse, would be most appropriate? a. "It is acceptable to bring candy, but you must give it to the nursing staff." b. "Why can't you bring vegetables instead of candy for the patient?" c. "You should not bring candy because the patient has diabetes." d. "The patient needs a healthy snack, and you can help by bringing fresh fruit."

"The patient needs a healthy snack, and you can help by bringing fresh fruit."

A student nurse is not able to start an IV after two attempts. Two staff nurses laugh and call the student nurse "stupid." The student nurse reports the staff nurses' behavior to the charge nurse. Which response by the charge nurse is best? a. "This is an example of verbal abuse and is inappropriate." b. "I think the nurses were just joking to relieve stress." c. "The staff nurses did not mean to hurt your feelings." d. "You just need more practice starting IVs."

"This is an example of verbal abuse and is inappropriate."

The nurse is a member of a quality improvement project team to improve communication when a patient is transferred to another unit. Which statement by the nurse is appropriate to demonstrate positive regard for the team members? A. "We have done an excellent job." B. "We still have so much work to do." C. "Most of our suggestions did not work." D. "We won't win a prize for our work."

"We have done an excellent job."

The nurse questions a patient with hypertension before developing a teaching plan. Which question, if asked by the nurse, is most appropriate? A. "How long have you had hypertension?" B. "Are you taking any blood pressure medications?" C. "What do you know about hypertension?" D. "Do you understand why salt is bad for you?"

"What do you know about hypertension?" Open questions (e.g., "What do you know about hypertension?") invite respondents to elaborate in whatever direction they choose. Closed questions are focused and posed to elicit specific and brief responses from clients. Questions (e.g., "Are you taking any blood pressure medications?" or "Do you understand why salt is bad for you?") that only require a "yes" or "no" do not invite the patient to elaborate further about the experience. Questions that require a short answer (e.g., "How long have you had hypertension?") do not provide an opportunity for the patient to elaborate further about hypertension.

The nurse cares for a patient who complains of back pain. Which question should the nurse ask to obtain specific information about the back pain? A. "Would you like medication for the pain?" B. "What have you been doing in the last few days?" C. "Do you have a family history of osteoporosis?" D. "What do you think caused the back pain?"

"What do you think caused the back pain?" To obtain specific information, the nurse must specifically ask for it (e.g., ask the patient about possible causes for the pain). It is more appropriate for the nurse to initially ask for the patient's perspective than about specific causes (e.g., osteoporosis or activity). The nurse should assess before taking action (e.g., offering pain medication); the intervention does not provide specific information about the back pain.

A client has high blood pressure and needs to learn about a low-sodium diet. Which question if asked by the client would be an indirect request for information? A. "How should I prepare food without adding salt?" B. "What will I do to make food taste better?" C. "What diet changes are needed to control my blood pressure?" D. "What foods should I avoid that are high in sodium?"

"What will I do to make food taste better?"

A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate? A. "I will teach the students how to read nutrition labels." B. "What would you like the students to learn about nutrition?" C. "The students need to know about the consequences of obesity." D. "I will enjoy teaching the students everything I know about nutrition."

"What would you like the students to learn about nutrition?" It is important to focus on the aspects of nutrition that the teacher wants the students to know and that are most important for them. The nurse should not assume the students need to learn about nutrition labels or obesity. Comprehensive nutrition information may waste time, be irrelevant, or focus on material that is too frightening or too advanced.

The home care nurse visits a mother and her newborn 2 days after discharge from the hospital. The mother states, "My baby cries all the time. I must not be a very good mother." Which response by the nurse is nontherapeutic? A. "It sounds as if you are concerned about your ability to care for your baby." B. "The nurse moves closer to the mother and places a hand on her shoulder." C. "You just need to get away for a few hours. Find a babysitter and go to a movie." D. "I am not sure that I understand what you mean. Tell me more about how you feel."

"You just need to get away for a few hours. Find a babysitter and go to a movie."

A patient reports to the nurse, "My doctor is not doing anything about my pain." Which response by the nurse is assertive and expresses warmth? A. "If I were you, I would see a different doctor." B. "What you really mean is you do not like your doctor." C. "It is wrong for you to blame your doctor." D. "You seem frustrated with your doctor."

"You seem frustrated with your doctor." An assertive statement that expresses warmth (i.e., "You seem frustrated with your doctor") engages in direct, fair confrontation with clear, honest statement of feelings; when the nurse conveys warmth and is assertive, a position of "I'm OK, you're OK" is assumed. Aggressive statements that lack expression of warmth include outright assaults or accusations (i.e., "It is wrong for you to blame your doctor"), making decisions for others (i.e., "If I were you, I would see a different doctor"), and labeling the other person (i.e., "What you really mean is you do not like your doctor").

The nurse cares for a patient with urinary incontinence after a stroke. Which response by the nurse is best? A. "You seem upset about this. We can work together on a bladder retraining program." B. "I don't mind cleaning up your mess. I am used to it because my child does this at night." C. "Don't be embarrassed. A lot of patients have this problem after a stroke." D. "I will bring you some diapers to wear instead of having you wet the bed all the time."

"You seem upset about this. We can work together on a bladder retraining program." The nurse must consider the client's self-esteem and preserve the client's dignity. Clients want to preserve or manage their image of self or "face." How the nurse handles a situation can influence the client's willingness to problem-solve.

A young mother who fractured her leg is sobbing with her face hidden behind her hands. She says to the nurse, "I will not be able to work for at least 2 months. Without my job, I cannot pay my bills or take care of my baby. I am alone and do not have anyone to help me." Which response by the nurse accurately conveys empathy? A. "Why do you think that no one cares about you or will refuse to help you?" B. "I can see that you are hesitant about relying on others because of low self-esteem." C. "You seem worried about how you will be able to take care of yourself and your baby." D. "I am sorry that you are uncomfortable with asking others for help right now."

"You seem worried about how you will be able to take care of yourself and your baby." An empathetic response is accurate and specific. The word "worry" accurately reflects verbal and nonverbal cues from the mother. The other statements by the nurse do not accurately reflect the mother's verbal and nonverbal cues.

The nurse cares for a patient who has just been diagnosed with lung cancer. Which statement by the nurse is therapeutic? A. "You sound really frightened about your diagnosis of cancer." B. "You will get better because the treatment will be started this week." C. "I think you should take a vacation and try to forget about the cancer." D. "An apple a day will keep the doctor away."

"You sound really frightened about your diagnosis of cancer."

It would be most important for the nurse to temporarily withdraw expressions of warmth to which patient? A. A 20-year-old patient who is angry and throwing objects. B. A 32-year-old patient who is withdrawn and refuses nursing care. C. A 48-year-old patient who is extremely anxious about surgery. D. A 56-year-old patient who has a history of violent behavior.

A 20-year-old patient who is angry and throwing objects. When the nurse feels hurt, bitter, irritated, or enraged with a patient, trying to convey warmth would be insincere. It would be appropriate to express warmth to patients who are withdrawn and anxious. Expression of warmth is appropriate for a patient with a history of violence; the patient is not exhibiting the violent behavior at this time.

In which situation(s) would it be appropriate for the nurse to communicate with empathy? (Select all that apply) A. An acquaintance who seeks a long-standing social relationship that is superficial. B. A patient who is anxious about a change in body image after a mastectomy. C. A supervisor who is searching for approval and recognition from staff. D. A colleague who expected a promotion but was not awarded the promotion. E. A client who has been alienated from family because of sexual orientation.

A colleague who expected a promotion but was not awarded the promotion. A client who has been alienated from family because of sexual orientation. A patient who is anxious about a change in body image after a mastectomy. It is appropriate to communicate with empathy when clients or colleagues are hurting, confused, troubled, anxious, alienated, terrified, doubtful of self-worth, or uncertain as to identity. The nurse should be cautious if the relationship involves a person in power such as an employer or superficial or romantic relationships.

The nurse manager decides to initiate a mentoring program for new graduate nurses on a medical unit. The nurse manager should consider asking which of the following three nurses to serve as mentors? (Select all that apply) A. A nurse who excels in nursing knowledge and skills and has a positive attitude. B. A nurse who has excellent communication skills and a positive outlook. C. A nurse who is certified in psychiatric care and works in a mental health setting. D. A nurse who excels as a manager and has an advanced degree in administration. E. A nurse who is warm, empathetic, and has a passion for nursing and helping others.

A nurse who excels in nursing knowledge and skills and has a positive attitude. A nurse who has excellent communication skills and a positive outlook. A nurse who is warm, empathetic, and has a passion for nursing and helping others.

Which nurse has achieved generative balance? a. A nurse who sets realistic goals, finds meaning, and renews energy b. A nurse who controls life events, accepts failure, and seeks perfection c. A nurse who has high expectations and focuses on professional success d. A nurse who provides for the needs of others at the expense of self care

A nurse who sets realistic goals, finds meaning, and renews energy

The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient's electronic medical record. Which key point should the nurse educator include in the teaching plan? (Select all that apply) A. A patient who is at high risk for falls will require more frequent documentation. B. The nurse should avoid labels (e.g., good, drug seeking, and lazy) to describe patients. C. Detailed and specific documentation is only required if a malpractice suit is expected. D. Each entry by the nurse in the electronic medical record should be clear and concise. E. Documentation cannot be used to determine reimbursement for healthcare services. F. Exact statements (in quotations) from patients are more accurate than paraphrasing.

A patient who is at high risk for falls will require more frequent documentation. The nurse should avoid labels (e.g., good, drug seeking, and lazy) to describe patients. Each entry by the nurse in the electronic medical record should be clear and concise. Exact statements (in quotations) from patients are more accurate than paraphrasing. The complexity of the health problems and the level of risk posed by patients, by their condition, or by the use of medical, nursing, or other therapies dictate the detail and frequency of documentation. The higher the risk to which a particular patient is exposed, the more comprehensive, in depth, and frequent should be the nursing recordings. Effective recording shuns bias, avoiding tendencies to prejudge or label patients. Avoidance of a malpractice suit is a valid reason for documentation to be detailed and specific, but documentation should be detailed and specific for every patient. Clear, concise documentation is vital for every entry into the electronic medical record. Careful documentation affects the ability of a healthcare agency to be reimbursed for services. Effective documentation tends toward quantitative expression, avoiding vague generalizations.

The nurse educator instructs staff nurses about how to respond effectively to colleagues who exhibit abusive behaviors. Which would indicate that teaching was effective if performed by a staff nurse? a. A staff nurse remains calm and controlled when a colleague is abusive. b. A staff nurse explains to an abusive colleague how the comments increase self- esteem. c. A staff nurse shares feelings with a colleague who is consistently aggressive. d. A staff nurse responds to an abusive colleague with aggression.

A staff nurse remains calm and controlled when a colleague is abusive.

A nurse who frequently corrects other staff nurses is trying to avoid making comments when it really does not matter. In which three situation(s) would it be appropriate for the nurse to remain silent and not share an opinion? (Select all that apply) A. A staff nurse reports a blood pressure as 110/60, but it is recorded in the chart as 114/62. B. A staff nurse takes a lunch break for 33 minutes instead of 30 minutes. C. A staff nurse gives a medication orally instead of by injection. D. A staff nurse reports no discrepancy for the narcotic count, but one is missing. E. A staff nurse does not pronounce the generic name of a medication correctly.

A staff nurse reports a blood pressure as 110/60, but it is recorded in the chart as 114/62. A staff nurse takes a lunch break for 33 minutes instead of 30 minutes. A staff nurse does not pronounce the generic name of a medication correctly. Nurses need to know when to express opinions and when not to share opinions and have the strength not to always be right. The nurse should not share opinions when it does not make a difference (e.g., insignificant differences in blood pressure readings, taking an extra 3 minutes for lunch, and mispronunciation of medical terms with colleagues). Opinions should be expressed if patient safety is involved (e.g., administering medication by the wrong route) or there are legal ramifications (e.g., a controlled substance is missing).

The nurse is performing a well-child assessment on a 15-month-old child. The child's mother and father are present. Which action by the nurse will best determine the health beliefs and values of the parents? A. Have the parents independently complete the Myers-Briggs Type Indicator survey. B. Read the documented health histories of the child's parents and grandparents. C. Actively listen to the parents talk about their lives and health concerns. D. Review the traditional health practices of the ethnic group identified by the parents.

Actively listen to the parents talk about their lives and health concerns.

The nurse cares for a young adult patient in the emergency room after a sexual assault. Which action by the nurse is appropriate? A. Avoid situations in which the patient will be involved with decision making. B. Tell the patient to join a local support group for sexual assault victims. C. Actively listen to the patient express feelings related to the sexual assault. D. Provide detailed information about evidence collection and invasive procedures.

Actively listen to the patient express feelings related to the sexual assault. The nurse should exhibit polite behaviors when interacting with patients who are fearful, embarrassed, or angry. Polite behaviors lessen the threat of intimate or invasive nursing actions (e.g., questions about behavior, physical assessment, and treatments). Active listening is an example of polite behavior. When discussing a potentially embarrassing situation, the nurse should be careful about the language used and ask questions gently. Nurses may tactfully encourage the patient's participation in decision making and problem solving. Nurses should avoid a direct order (e.g., joining a support group) because it is considered impolite and inappropriate.

Which three situations below would be appropriate for the nurse's use of confrontation? (Select all that apply) a. Another nurse consistently withholds pain medication from Hispanic patients. b. A parent continues to smoke in the presence of a child who is diagnosed with asthma. c. A patient asks several questions about newly prescribed medications. d. A pregnant woman drinks 2 to 4 alcoholic beverages each day. e. A staff nurse is selected by a nursing supervisor to attend a conference.

Another nurse consistently withholds pain medication from Hispanic patients. A parent continues to smoke in the presence of a child who is diagnosed with asthma. A pregnant woman drinks 2 to 4 alcoholic beverages each day.

The nurse cares for a patient who becomes confused and a vest restraint is applied. The nurse should take which action when notifying the patient's family? A. Avoid discussing the treatment plan to reduce anxiety and worry. B. Ask another nurse who has rapport with the family to be present. C. Use medical terms to demonstrate competence. D. Assume that the family wants a detailed explanation.

Ask another nurse who has rapport with the family to be present. Rapport should be established before bad news is shared with the family; if rapport has not been developed, the nurse may ask team members who have established rapport with the family to be present. The nurse should use language that the family will understand. Find out how much detail the family wants to know. Explain the treatment plan to the family.

A graduate nurse is concerned about making the transition to nursing practice. It is most appropriate for the graduate nurse to take which action? a. Set professional goals with lofty expectations. b. Ask appropriate individuals for assistance. c. Delay joining professional associations. d. Work extra shifts to gain more experience.

Ask appropriate individuals for assistance.

The home health nurse visits a client with heart failure who has increased dyspnea and peripheral edema and weight gain. The nurse suspects the client is not restricting fluids as prescribed. Which action by the nurse is most appropriate? A. Teach the client about the consequences of not following the fluid restrictions. B. Ask the client to report the amount of fluid intake for the past 24 hours. C. Provide the client with sugarless candy or gum to decrease the thirst sensation. D. Consult with the healthcare provider about increasing the dose of the diuretic.

Ask the client to report the amount of fluid intake for the past 24 hours. Client validation of the assessment data leads to mutual problem-solving with the nurse. Incorporating validation keeps nurses focused on the rights and obligations of clients to make their own decisions about their health. Validation means consciously seeking out the client's opinions and feelings, unearthing questions or concerns related to plans for their healthcare, and securing an understanding and willingness to proceed to the next step. Incorporating validation into problem-solving ensures that the nurse obtains complete agreement and commitment from the client about the nursing care plan.

The nurse cares for a patient who is scheduled for abdominal surgery. Which action, if taken by the nurse, is most appropriate? A. Mandate the use of a complementary therapy such as guided imagery. B. Administer opioids for pain rated more than 3 (on a 0 to 10 pain scale). C. Ask the patient about expectations for postoperative pain management. D. Provide pain management based on a standardized nursing care plan.

Ask the patient about expectations for postoperative pain management. The nurse in collaboration with the patient should set priorities and determine expected and desired outcomes related to management of pain after surgery. Interventions to manage postoperative pain should be discussed with the patient. The patient and nurse should collaborate and determine appropriate pain management interventions. In addition, the pain management interventions should be individualized for each patient.

Andy Andrews, a well-known author and speaker, was once homeless and lived on the streets for a season of his life. Discussing the lessons learned as he looked back over his journey, he was quoted as recommending one of the following as a key to moving forward: A. Ruminating about alternatives B. Asking proper questions C. Utilizing negative self-talk D. Increasing your self-advocacy

Asking proper questions Many of life's treasures remain hidden from us simply because we never search for them. Often we do not ask the proper questions that might lead us to the answer to all our challenges (Andy Andrews, 2011). He did not recommend ruminating about alternatives, utilizing negative self-task, or increasing your self-advocacy.

The nurse is providing care to a patient who was admitted with heart failure. The patient has not been following the prescribed diet or taking the prescribed medications. Which type of communication approach is most important for the nurse to use with this patient to facilitate a change in self-care behavior? A. Authoritative, honest, and outright communication B. Assertive, responsible, and caring communication C. Aggressive, sympathetic, and realistic communication D. Positive, expert, and focused communication

Assertive, responsible, and caring communication

In 2015, the American Nurses Association (ANA) updated their Code of Ethics. Under the "Promotion of Personal Health, Safety, and Well-being," it mandates self care to responsibly cope with the stressors of nursing. Thinking through the list and how it applies to you, which of the following would not be in line with the ANA recommendations? a. Healthy diet and exercise b. Attending to spiritual or religious needs c. Engage in adequate leisure and recreational activities d. Break ties with family and personal relationships

Break ties with family and personal relationships

According to the NCSBN, appropriate self-disclosure is a part of maintaining professional boundaries. Appropriate self-disclosure includes the following: A. Discussing intimate or personal values with patients B. Keeping secrets with a patient or for a patient C. Expressing you are the only one who truly understands patient D. Brief, focused, and only used if experience is similar

Brief, focused, and only used if experience is similar Self-disclosure should be brief and should be used only if your experience is similar. It is better to choose not to use this technique if you have not had the experience. The NCSBN brochure described some of the red flag behaviors, warning signs that the relationship could be crossing a boundary and violating patient rights.

Which describes characteristics of mutuality in the nurse-client relationship? (Select all that apply) A. Dependency B. Collaboration C. Paternalism D. Acceptance of differences E. Empathy

Collaboration Acceptance of differences Empathy

As a part of the F.O.C.U.S. model, the "C" stands for A. Communicate B. Connect C. Concern D. Convince

Connect

A nurse manager seeks to reduce staff nurses' stress and promote retention. It is most important for the nurse manager to take which action? A. Develop a mentoring program to provide cognitive and affective support. B. Focus on cognitive support instead of affective or physical support. C. Limit affective support to annual recognition of nurses' accomplishments. D. Place the highest priority on purchasing equipment to provide for physical support.

Develop a mentoring program to provide cognitive and affective support.

While admitting a patient to the medical unit, the nurse should take which action? A. Demonstrate human caring by hugging the patient for brief intervals. B. Disclose shared intimate details with other healthcare providers. C. Maintain a physical distance of at least 3 to 4 feet at all times. D. Develop the plan of care and measurable objectives with the patient.

Develop the plan of care and measurable objectives with the patient.

REAL conversations, as described by John Stoker (2013), should contain multiple facets. As a nurse, we know when approaching patients, our care should be REAL, meaning we should do all of the following except: A. Recognize judgments B. Express biased thoughts C. Ask questions D. Listen for verbal and nonverbal messages

Express biased thoughts "REAL conversation: Recognize judgments. Express thoughts neutrally. Ask questions. Listen for verbal and nonverbal messages" (John Stoker, 2013).

You are teaching unlicensed personnel about the basics of hospice care. You know that according to NHPCO, hospice care is based on all of the following beliefs except: a. Dying is a normal part of life. b. The concept of living until you die. c. Family should be spared the pain of seeing loved ones go through the process. d. The patient right to die pain free.

Family should be spared the pain of seeing loved ones go through the process.

A nurse preceptor is assigned to help several graduate nurses assess their ability to convey warmth to patients. Which activity, if selected by the nurse preceptor, is best? A. Set up sessions for the graduate nurses to practice various nonverbal gestures. B. Ask the graduate nurses to record the behaviors of experienced nurses on the unit. C. Provide the graduate nurses with a list of nonverbal behaviors that convey warmth. D. Have the graduate nurses evaluate each other during simulated patient interviews.

Have the graduate nurses evaluate each other during simulated patient interviews. A simulated patient interview that is evaluated would provide the best opportunity for the graduate nurses to develop skills to assess warmth and to receive feedback on personal warmth skills. A list of nonverbal behaviors does not foster active learning. Nonverbal gesture practice does not help graduate nurses learn how to assess warmth skills with a patient. Recording nonverbal behaviors is observation and does not give the graduate nurses a specific experience in assessment of warmth skills.

The nurse makes a home visit to a client with chronic kidney disease. The client asks the nurse to make the decision about whether or not to start dialysis. Which action by the nurse is most appropriate? A. Encourage the client to appoint a durable power of attorney. B. Invite the client to make a decision after reviewing options. C. Direct the client to have the physician make a decision. D. Have the client visit with an individual receiving dialysis.

Invite the client to make a decision after reviewing options. Nurses should encourage clients to be active, responsible partners in their care; the nurse encourages a mutual problem-solving process by inviting or requesting the full participation of clients. A durable power of attorney can be authorized to make healthcare decisions if clients are no longer able to speak for themselves. Having the physician make decisions for the client places the client in a passive role. The client may visit with another person receiving dialysis, but the decision should be made by the client.

The nurse plans to use self-disclosure to aid a mother and father in the grieving process after the death of their child. The steps of a helpful self-disclosure appear below. What is the first step? A. Succinctly share a personal experience that is a similar grieving experience. B. Listen to the parents talk about their child and observe their movements and gestures. C. Reflect upon the parent's statements to communicate understanding. D. Seek verification that the self-disclosure was helpful to the child's parents.

Listen to the parents talk about their child and observe their movements and gestures. The steps to successfully implement helpful self-disclosure are (1) actively listen to the parents' verbal and nonverbal messages (2) reply with an empathic response (3) self-disclose for the benefit of the parents (4) check to see if the empathic response and self-disclosure were effective.

The nurse cares for a female patient who is trying to gain understanding of her life and her diagnosis of metastatic breast cancer. Which approach by the nurse would best meet this patient's needs? A. Suggest the patient join a breast cancer support group. B. Provide the patient with reading material on death and dying. C. Contact the patient's spiritual leader to request daily visits. D. Listen to the patient's stories about her past experiences.

Listen to the patient's stories about her past experiences.

The home health nurse cares for a patient who is diagnosed with chronic obstructive pulmonary disease. Which response(s) and behavior(s) by the nurse would indicate that bonding between nurse and patient has occurred? (Select all that apply) A. Expects the patient to meet the goals for exercise as determined by the nurse. B. Listens to the patient describe the feelings of anxiety related to severe dyspnea. C. Develops teaching plan based on the learning preferences of the patient. D. Refrains from touching the patient unless performing physical assessment techniques. E. Requests that the patient wait to ask questions until the end of the home visit. F. Learns the names of the patient's family members and close friends and neighbors.

Listens to the patient describe the feelings of anxiety related to severe dyspnea. Develops teaching plan based on the learning preferences of the patient. Learns the names of the patient's family members and close friends and neighbors.

According to Swanson's theory, there are five caring processes, one of which is "knowing." What are the other four? A. Communication, assertiveness, responsibility, and caring B. Maintaining belief, being with, doing for, and enabling C. Understanding, action, information, and comfort D. Maintaining belief, being with, enabling, and supporting

Maintaining belief, being with, doing for, and enabling

Several studies have demonstrated that perceived social support is related to improved outcomes. When assessing your patients, you remembered that the textbook author had described research involving several different groups that had greater outcomes when social support was present. Which of the following was not one of those groups? A. Secondary school teachers B. Neighbors C. Veterans D. Stroke survivors

Neighbors

The author describes the patient journey as driving down a country road and somehow getting lost. At that moment and time, all that is needed is clear directions about how to get to your destination, not about types of entertainment in the area. The same is true for patients. Accordingly, a part of each nursing assessment should include: A. Patient's need for information and level of understanding B. Detailed overview of disease process C. Specific examples from other patients with same disease D. Nurse's feelings about newest treatment modality

Patient's need for information and level of understanding Assessment of patient's need for information and level of understanding helps the nurse choose the right amount of detail and appropriate language level (Black, 2014).

According to the ANA's Standards of Clinical Nursing Practice, there are several steps within the nursing process that surround patient care. However, one of the most important steps is the one in which the nurse partners with the patient, family, and other caregivers to create an acceptable path that meets the patient's needs and is specific to the disease process. This important step is identified as: A. Evaluation B. Planning C. Implementation D. Nursing diagnosis

Planning The standards set forth in Standards of Clinical Nursing Practice by the American Nurses Association (2010)—assessment, diagnosis, outcome identification, planning, implementation, and evaluation—provide support for a mutual problem-solving approach with clients. During planning, the registered nurse develops an individualized plan in partnership with the person, family, and others considering the person's characteristics (2010, p. 36).

The nurse cares for a patient who is angry about not being able to smoke while in the hospital. Which measures should the nurse implement when formulating a response to this patient? (Select all that apply) a. Remain calm and take a few deep breaths before speaking. b. Choose words that convey respect for the patient. c. Take the angry behavior personally to avoid misunderstandings. d. Stay a distance of 3 to 6 feet away from the patient. e. Respond with aggression to provide a safe environment.

Remain calm and take a few deep breaths before speaking. Choose words that convey respect for the patient. Stay a distance of 3 to 6 feet away from the patient.

A nurse is uncomfortable when asking patients about their sexual practices and behaviors. It is most appropriate for the nurse to take which action? A. Avoid asking these questions unless the patient initiates a discussion on sexual behaviors. B. Practice asking these types of questions in a simulated situation with a colleague. C. Ask a nurse who is comfortable with these types of questions to interview the patient. D. Tell the patient that asking sexual questions is difficult and uncomfortable for a nurse.

Practice asking these types of questions in a simulated situation with a colleague. To improve the ability to be at ease when asking questions in a variety of areas, the nurse may rehearse with friends or colleagues. If the nurse cannot overcome being uncomfortable with asking sexual questions, the nurse should be honest with the patient or have another nurse interview the patient. The nurse should not avoid asking questions regarding sexual behavior.

Which three technique(s) should be avoided when the nurse questions patients? (Select all that apply) A. Use questions that are worded clearly with words the patient understands. B. Provide a detailed explanation to introduce the rationale for the questions. C. Offer the patient options and tell the patient which option is preferred. D. Avoid asking a patient "why" by rephrasing the question if possible. E. Ask three to five questions at a time, and then allow the patient to answer.

Provide a detailed explanation to introduce the rationale for the questions. Offer the patient options and tell the patient which option is preferred. Ask three to five questions at a time, and then allow the patient to answer. The nurse should provide a concise statement as a rationale for questioning. If the nurse offers the patient options, the nurse should allow the patient time to speak and make a decision without interruptions. The nurse should not ask a string of questions because the patient may become confused and not know what information is important or where to begin answering. The nurse should not use medical terminology, abbreviations, or medical jargon that the patient does not understand. When asking the patient questions, the nurse should refrain from using "why" by rephrasing the question so it is softer and more receivable.

While dressing up shows respect for the organization and person who interview you, there are several behaviors recommended during job interviews. These include all of the following except: a. Volunteering personal information b. Keeping answers short and concise c. Enthusiasm about prospective job d. Rambling aimlessly

Rambling aimlessly

The nurse cares for the mother of a child who died in the emergency room as a result of an accidental poisoning. Which response by the nurse is appropriate? A. Place a greater emphasis on nonverbal aspects of empathy over verbal. B. Accurately reflect on the mother's feelings to convey understanding and concern. C. Repeat exact phrases stated by the mother to aid in expressions of grief. D. Reflect on the expressed feelings of the mother but with the nurse's own words

Reflect on the expressed feelings of the mother but with the nurse's own words

While teaching unlicensed assistive personnel, you know they did not understand the concept if they believed that the following was another name for healthcare workplace bullying: a. Relational assertiveness b. Nurse-to-nurse hostility c. Horizontal violence d. Psychological terror

Relational assertiveness

Which facial feature, if displayed by the nurse, best conveys warmth? A. Small pupils and a fixed gaze B. Furrowed brow and a wrinkled forehead C. Pursed lips and a forced smile D. Relaxed muscles and a concerned expression

Relaxed muscles and a concerned expression Facial features that convey warmth include the following: (1) face moves in a relaxed, fluid way; worried, distracted, or fretful looks are absent; face shows interest and attentiveness; (2) pupils are dilated; gaze is neither fixed nor shifting and darting; (3) lips are loose and relaxed, not tight or pursed; smile is not forced, jaw is relaxed and mobile, not clenched; and (4) forehead muscles are relaxed, and forehead is smooth; there is no furrowing of the brow.

Which nonverbal action(s) would be consistent with an assertive style of communication? (Select all that apply) A. Relaxed posture B. Established eye contact C. Hands placed on hips D. Distant, soft voice E. Mask-like facial expression

Relaxed posture Established eye contact

The charge nurse observes a staff nurse delegate inappropriate tasks to a nursing assistant. Which action by the charge nurse is most appropriate? a. Avoid talking about the situation with the staff nurse. b. Continue to observe the staff nurse's behavior for 3 months. c. Respectfully request that the staff nurse use appropriate delegation. d. Post delegation guidelines in the report room.

Respectfully request that the staff nurse use appropriate delegation.

One study of Italian primary care physicians caring for diabetic patients showed that those scoring highest on the empathy test had patients with: A. Significantly fewer acute diabetic complications B. Statistically fewer acute diabetic complications C. Higher rates of chronic diabetic complications D. Statistically higher poor outcomes for patients with diabetes

Significantly fewer acute diabetic complications

A client uses offensive language when communicating with the nurse. The nurse plans to confront the client in a caring, respectful manner. What is the element of confrontation that the nurse should do first? a. Ask the client to avoid using offensive language. b. Tell the client that offensive language is a problem. c. Explain positive consequences of using appropriate language. d. Describe how the offensive language is disrespectful of others.

Tell the client that offensive language is a problem.

A patient is attracted to the nurse and attempts to initiate a social relationship. It is most appropriate for the nurse to take which action? A. Encourage the client's behavior to develop a trusting nurse-client relationship. B. Inform the charge nurse of the situation and ask for a different patient assignment. C. Tell the patient that the relationship must remain professional at all times. D. Determine if the patient can be transferred to another nursing care unit.

Tell the patient that the relationship must remain professional at all times. Attraction may occur if the client attempts to turn a professional relationship into a social relationship. Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. The nurse should tell the client that it is important for the relationship to remain professional. The nurse should not encourage the client's behavior; attraction does not build trust in the nurse-client relationship. The nurse should attempt to talk with the patient instead of avoidance by either requesting a different patient assignment or transferring the patient to another unit.

The nurse cares for a client who has several options for cancer treatment. Which document supports the client's right to have access to information about treatment options? A. The Standards of Clinical Practice B. An Advance Health Care Directive C. The Patient's Bill of Rights D. A Client's Living Will

The Patient's Bill of Rights The Patient's Bill of Rights (presented by the American Hospital Association) describes the expectations for respect, knowledge, privacy and confidentiality, and access to any information essential for adequate treatment. The Standards of Clinical Practice (by the American Nurses Association) provide standards for quality of care, diagnosis, outcome identification, planning, implementation, and evaluation. A Client's Living Will is a document that identifies healthcare preferences (related to care intended to sustain life) if the client is incapacitated. An Advance Health Care Directive is a legal document that indicates a client's wishes about healthcare.

An experienced nurse supervises a novice nurse interviewing a patient. The experienced nurse should intervene if which is observed? A. The novice nurse uses simple language instead of medical terms. B. The novice nurse avoids asking the patient "why" questions. C. The novice nurse leaves the patient without providing feedback. D. The novice nurse asks mostly open-ended health history questions.

The novice nurse leaves the patient without providing feedback. The nurse should give patient feedback after an interview to help the patient feel connected and respected. Patients feel left out when nurses end an interview without giving them any indication of the assessment. Informing patients of what is happening, including plans and what patients can expect, provides helpful transitions so that they can map their progress, feel included, and minimize worrying about erroneous assumptions. The nurse should use simple language, avoid "why" questions, and use mostly open- ended questions.

According to Swanson's theory, there are five caring processes, one of which is "being with." Which of the responses by the nurse portrays an understanding of the concept of "being with" a client? A. The nurse charting in the room to spend more time with the client B. The nurse wearing locator badge so you can quickly respond any time patient would call front desk and ask to page you C. The nurse requesting one-on-one nurse staffing D. The nurse being emotionally present to the client

The nurse being emotionally present to the client

A nurse is breastfeeding but has no private, sanitary area to pump breast milk while working. She also discovers that at least 10 other employees at the hospital have the same problem. Which action by the nurse would most likely result in acquiring a clean, private area to pump breast milk as required by law? A. The nurse demands that the nursing director provide a private area within 1 week. B. The nurse develops a clear, detailed plan and suggests several possible private areas. C. The nurse sends an e-mail to the nursing supervisor with a description of the problem. D. The nurse writes a letter to the nurse manager and asks others to add their signatures.

The nurse develops a clear, detailed plan and suggests several possible private areas.

Which are examples of a nurse who is communicating responsibly? (Select all that apply) A. The nurse uses profanity to respond to a client who is intoxicated and verbally abusive. B. The nurse helps a client talk to family members about discontinuing chemotherapy. C. The nurse uses interpersonal strategies to help a client develop methods of coping. D. The nurse provides a client's health information to a close relative who is visiting. E. The nurse listens carefully to the client's concern about inadequate pain relief.

The nurse helps a client talk to family members about discontinuing chemotherapy. The nurse uses interpersonal strategies to help a client develop methods of coping. The nurse listens carefully to the client's concern about inadequate pain relief.

The nurse manager is interviewing several nurses who have applied for a position as a hospice nurse. It is most important for the nurse manager to assess each applicant for which qualities below? (Select all that apply) a. The nurse tends to patient care needs before personal self care. b. The nurse is able to compassionately listen to a dying patient. c. The nurse provides care based on the dying patient's wishes. d. The nurse is able to provide automatic, reassuring responses. e. The nurse is calm and able to create a peaceful environment.

The nurse is able to compassionately listen to a dying patient. The nurse provides care based on the dying patient's wishes. The nurse is calm and able to create a peaceful environment.

A graduate nurse experiences reality shock when transitioning to a staff nurse position on an oncology unit. Which of the following would be a reflection of that shock phase? a. The nurse is frustrated because of time constraints that were not experienced as a student. b. The nurse realizes that there is hope when caring for patients who are dying. c. The nurse experiences energy and excitement when providing nursing care. d. The nurse is able to resolve conflict and identify appropriate and attainable goals.

The nurse is frustrated because of time constraints that were not experienced as a student.

The nurse discusses smoking cessation with a client. Which action, if taken by the nurse, would most likely result in a behavior change? A. The nurse should advise the client to contact the national telephone quitline. B. The nurse should recommend nicotine replacement and behavioral interventions. C. The nurse should collaborate with the client to develop an individualized plan of action. D. The nurse should implement a strategy that has been validated by research.

The nurse should collaborate with the client to develop an individualized plan of action. The nurse should include validation in the nursing process; validation and collaboration with the client increase the probability of a successful change in behavior (e.g., smoking cessation). Specific interventions that are evidence based are appropriate, but the nurse should include the client in the nursing process or the problem-solving process.

The community health nurse is listening to a client talk about a personal problem. Which of these actions by the nurse is most appropriate? A. The nurse should increase the physical distance from the client. B. The nurse should lean toward the client and make eye contact. C. The nurse should periodically interrupt the client to ask questions. D. The nurse should initiate the physical assessment to distract the client.

The nurse should lean toward the client and make eye contact.

The nurse cares for an adult client diagnosed with type 1 diabetes mellitus. Which is essential in building mutuality in the nurse-client relationship? A. The nurse controls the relationship by retaining the power to make judgments about diabetes education. B. The nurse teaches diabetes management by involving the client in making decisions about self care. C. The nurse has expert knowledge of diabetes and formulates appropriate learning outcomes for the client. D. The nurse demonstrates trust and respect by solving problems for the client when issues occur with self-management.

The nurse teaches diabetes management by involving the client in making decisions about self care. Mutuality is an essential element in building relationships with the client and is characterized by empathy, collaboration, equality, and interdependency. Mutuality is a sharing of collective knowledge and decision making.

Three emergency department (ED) nurses are interested in initiating a new policy related to family presence during cardiopulmonary resuscitation (CPR). The steps a nurse would utilize to request support for initiation of this policy are listed below. What is the first step? A. The nurses review literature and survey ED nurses about family presence during CPR. B. The nurses practice their presentation to the nurse manager. C. The nurses identify the need to gain support from the nurse manager for this policy. D. The nurses decide to approach the nurse manager with their idea. E. The nurses develop a specific strategy to present the information to the nurse manager.

The nurses identify the need to gain support from the nurse manager for this policy.

The nurse cares for a client with hypertension, and a nurse-client contract is developed outlining the activities and responsibilities of each. Which would be appropriate to include in this contract? (Select all that apply) A. The outcomes should be realistic and measurable. B. Progress should be reviewed at regular intervals. C. The contract should be written and signed. D. The nurse should keep the information confidential. E. The nurse and client should mutually evaluate progress.

The outcomes should be realistic and measurable. Progress should be reviewed at regular intervals. The nurse and client should mutually evaluate progress. The contract should be realistic and spell out measurable behaviors. The nurse and client should mutually evaluate outcome achievement at regular intervals. The contract may be either verbal or written. The nurse should not promise to keep information confidential; nurses must share information that is important to the well-being of the client or others (e.g., plans to harm self or others).

A male patient with hypertension tells the nurse that he follows the reduced sodium diet and takes the antihypertensive medication as prescribed. The patient has had no reduction in blood pressure. The nurse plans to confront the patient regarding this discrepancy. Which indicates to the nurse that confronting the patient is effective? a. The patient tells the nurse that it was not his fault that the prescribed treatment failed. b. The patient cooperates with prescribed treatment and an actual behavior change occurs. c. The patient shares feelings about his diagnosis and refuses to make any changes. d. The nurse provides information for the patient to make an informed decision.

The patient cooperates with prescribed treatment and an actual behavior change occurs.

The nurse cares for a client who is scheduled for a breast biopsy. Which is the main purpose of the client-nurse relationship? A. To develop a mutually satisfying experience for the client and nurse. B. To assist the client in achieving and maintaining optimal health. C. To provide excellent client service and improve quality of care. D. To allow the client to receive important health information.

To assist the client in achieving and maintaining optimal health.

The nurse greets a patient who is admitted to the hospital. Which action by the nurse displays warmth and concern? A. Use a soft and relaxed tone of voice when speaking. B. Maintain a distance of 6 to 8 feet from the patient. C. Avoid attentive behaviors when interacting with the patient. D. Engage in a verbal exchange without physical contact.

Use a soft and relaxed tone of voice when speaking. A soft, modulated tone of voice conveys warmth; warmth is also conveyed with relaxed, rhythmic speech. The spatial distance between the nurse and the patient can affect the perception of warmth; a comfortable, social distance for Americans is an arm's length to 4 feet. Touching (e.g., brief pat on the shoulder, embracing hug, or extended hand) is another way to transmit warmth. A relaxed person conveys warmth. The nurse communicates warmth when there is a genuine interest and attentiveness in the interaction with the patient.

A new graduate nurse feels that the staff nurses are not empathetic and do not provide reassurance or positive feedback. Which action by the graduate nurse is appropriate? A. Use an antagonistic approach to seek support from a nurse who is a mentor. B. Use a nonassertive approach to seek physical support from the staff nurses. C. Use an assertive approach to seek affective support from the nurse manager. D. Use an aggressive approach to seek cognitive support from other graduate nurses.

Use an assertive approach to seek affective support from the nurse manager.

The nurse cares for an elderly patient in a long-term care center. Which would be inappropriate for the nurse to share with the client? A. Reminisce about birthday celebrations and inquire about the client's traditions. B. Use high levels of intimacy to help the client feel more comfortable with the nurse. C. Establish a helping relationship based on trust by sharing a personal story with the client. D. Share with the client how meditation decreased nausea during chemotherapy treatment.

Use high levels of intimacy to help the client feel more comfortable with the nurse. The following are recommendations for the sharing of self in a geriatric practice: (1) self- disclosure helps the client get to know the nurse without the burden of high levels of intimacy (2) reminiscence is enhanced in elders when they are encouraged to share specific events (e.g., speak of personal holiday traditions and question clients about theirs) (3) understand that the connection between nurse and patient is dynamic, and the perception of the nurse as a real person aids in establishing the helping relationship (4) the nurse's sharing of self may help decrease the client's anxiety and diminish the stress of illness and treatment.

A nurse who cares for patients in the emergency department is distressed, fatigued, and frustrated by the demands of the job. Which are appropriate methods for the nurse to renew energy and find meaning in nursing practice? (Select all that apply) a. Walk briskly with a friend three to four times a week for 30 minutes. b. Start a journal to express feelings of joy, sadness, enthusiasm, or frustration. c. Set aside time with other nurses to complain about problems at work. d. Practice guided imagery or muscle relaxation two times each day. e. Explore other occupations or change jobs every 1 to 2 years.

Walk briskly with a friend three to four times a week for 30 minutes. Start a journal to express feelings of joy, sadness, enthusiasm, or frustration. Practice guided imagery or muscle relaxation two times each day.

A hospital nurse is concerned about the demands of providing safe care to clients who are seriously ill. The nurse manager should suggest which intervention to effectively help the nurse balance the demanding work in the hospital setting? A. Delegate more tasks to the unlicensed nursing personnel on the unit. B. Request a transfer to another nursing care unit with patients who are stable. C. Write down stories in a journal about how caring makes a difference for patients. D. Use an assertive communication style for every patient-nurse interaction.

Write down stories in a journal about how caring makes a difference for patients.