Communication – questions – Flashcards
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The most likely reason a 9-year-old child cries and refuses to cooperate with an injection is: A. the child's past experiences with injections. B. the environment the child finds himself in, such as a hospital emergency room. C. the precipitating event, such as a fall that resulted in the need for a local anesthetic. D. the nurse's verbal and nonverbal communication with the child about the injection.
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A Previous experiences with injections are likely to have the greatest impact on the way a child will interpret any communication about an injection.
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The most important concept to remember when using both verbal and nonverbal communication is that: A. people are more likely to accept verbal messages than nonverbal ones. B. nonverbal messages are accepted as true more often than verbal ones. C. touch as a nonverbal form of communication should be avoided. D. avoiding eye contact is viewed as being untruthful by all cultures.
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B An important concept to remember is that when the verbal message and the nonverbal message do not agree, the receiver is more likely to believe the nonverbal message since body language is often the most trusted indicator for conveying feelings, attitudes, and emotions. Touch is appropriate and useful when accepted by the client. In some cultures, avoiding eye contact is viewed as being respectful.
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The primary goals of good relationship building and client care are best achieved when all members of the interprofessional care team: A. have identified the team's leader. B. are experts in their field of care. C. have developed a trusting relationship. D. recognize their role in the client's care.
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C The need for trust in the health care setting is not limited to the nurse-patient relationship but rather pervades all working relationships. Care is more effective when the nursing team and the interprofessional team share the essential element of trust. Although the other options are factors in relationship building and client care, they would all be affected by a lack of trust among team members
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When a client expresses doubt whether a complicated procedure will actually help his condition, the nurse best avoids blocking the communication by responding: A. "I can understand your concern. We can talk more about it whenever you want." B. "Your physician has performed this procedure many times and with great success." C. "What makes you doubt that your condition will benefit from having the procedure done?" D. "Would you like me to arrange for someone who has had the procedure talk to you about it?"
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C By opening the communication up to further discuss the client's concerns, the nurse has validated the client's feelings, acknowledged his concerns, and provided the opportunity for further communication. The other options, while providing support and encouragement, do not open communication for further information gathering
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Nursing's primary concern related to the appropriate use of social media is to preserve: A. confidentiality. B. professionalism. C. cultural sensitivity. D. effective communication.
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A The nurse must be acutely aware of the need to preserve the client's privacy and the confidentiality regarding client information. The nurse must also be aware of the consequences of failing to do so effectively. The other options may be affected by social media posting but the client issue of primary concern is confidentiality.
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A patient states, "No one talked with me about a change in my medications, so just bring me what I take at home." Which of the following responses by the nurse is the best example of a therapeutic communication technique? A. "You must take your medications to get better and return home." B. "Your doctor wouldn't have prescribed these if you didn't need them." C. "Why don't you trust the care that you're receiving?" D. "I understand that you're concerned. Let me tell you about the medications."
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D Validating the patient's concerns and addressing the expressed concern by providing information is the most therapeutic response.
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A patient states, "I'm not sure my doctor has ordered the right medication for my hypertension." Which of the following responses is the most therapeutic as an immediate response? A. "So you're concerned that this medication may not be right for you?" B. "Why don't you think this is the right medication?" C. "I'll get some written information about this medication for you to read." D. Use silence and direct eye contact until the patient speaks again.
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A The use of paraphrasing is an important therapeutic technique that allows the patient to provide meaning.
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A nurse is attempting to establish a therapeutic relationship with an angry, depressed patient on a medical surgical unit. Which of the following is the best nursing intervention? A. Use humor to soften the intensity of the patient's anger. B. Establish a social friendship with the patient. C. Empathize with the patient as he describes current stressors. D. Establish daily time limits for the patient to talk negatively about his situation.
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C The use of empathy can establish a therapeutic relationship and reduce barriers to the relationship caused by anger or depression.
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You are caring for an 80-year-old woman, and you ask her a question while you are across the room washing your hands. She does not answer. What should you do next? A. Leave the room quietly because she evidently does not want to be bothered right now. B. Repeat the question in a loud voice, speaking very slowly. C. Move to her bedside, get her attention, and rephrase the question while facing her. D. Bring her a communication board so she can express her needs.
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C It is essential to allow a patient, particularly one who may be hearing impaired or elderly, to see the speaker to ensure therapeutic communication. Removing distractions, including noise, is also important.
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Which of the following nursing actions helps you establish a therapeutic relationship with a patient for whom English is not the primary language? A. Call all patients by first name unless they request otherwise. B. Provide the patient with a professional interpreter. C. Perform all care as quickly as possible and leave the room so the patient can rest. D. Engage in personal conversations with other members of the health care team while providing care.
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B Providing culturally competent care includes securing an appropriate interpreter and providing written materials in the patient's primary language.
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A 68-year-old man was diagnosed with Alzheimer's disease 4 years ago. The patient's cognitive abilities have since deteriorated, and the patient is withdrawn and frustrated. Which nursing intervention would be most helpful when communicating with this patient with a cognitive disorder? A. Stand within 6 inches of the patient when providing direction. B. Speak in a low monotone voice when communicating with the patient. C. Ask only "yes" and "no" questions when talking to the patient. D. Break tasks into small steps, giving one instruction at a time.
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D Effective techniques for providing care to patients with special needs include breaking tasks into small steps and giving instructions one at a time.
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A female patient of Native American descent is upset and tells the nurse that the nursing assistant makes her feel uncomfortable when he looks into her eyes. Which of the following interventions is most appropriate for the nurse? A. Promote cultural sensitivity by teaching the nursing assistant that direct eye contact can be misinterpreted by some Native Americans. B. Ask the patient about a sexual abuse history. C. Assure the patient that the nursing assistant will be assigned to other patients. D. Inform the patient to use the Patient Satisfaction Survey to record her concerns anonymously.
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A Patients of Native American descent interpret direct eye contact as threatening. Ensuring culturally competent care is essential.
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An 84-year-old man is admitted to a medical floor for severe malnutrition and dehydration. His wife, who has been the sole dependent care agent, appears tired, frail, and angry when she visits. She remarks, "Let's see what you can do with him." The nurse's most therapeutic response would be: A. "You must be relieved that your husband didn't die." B. "Tell me what you mean by, 'Let's see what you can do with him.'" C. "We know how to care for patients like your husband." D. "It's too bad you didn't have any help to care for him at home."
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B Seeking clarification is an important therapeutic communication technique.
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A nurse has a new surgical patient whose temperature spiked to 102.9° F. The nurse calls the health care provider using SBAR to structure the communication. Which order should the nurse communicate the patient information? 1. The surgical site is clean and dry. 2. The patient has a history of systemic infections. 3. The patient is febrile. 4. The nurse requests an order for an antipyretic. A. 3, 2, 1, 4 B. 2, 3, 1, 4 C. 3, 1, 2, 4 D. 2, 4, 1, 3
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A The standard use of S (Situation), B (Background), A (Assessment), and R (Recommendation) provides a universal approach to hand-off communication.
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A nursing professor overhears a nursing student say to a patient, "This is your third admission this month. Why did you stop taking your medication again?" Which of the following statement(s) would be most helpful for the student nurse to hear from her clinical instructor? (Select all that apply.) A. "Asking a why question could be interpreted as criticism. How could you have asked your question differently?" B. "Your question is good because it forced the patient to describe his thoughts and feelings about being medication noncompliant." C. "Your nonverbals showed genuine concern for your patient's readmission. It is important that your verbal statements and nonverbal messages match to avoid sending mixed messages." D. "I like the way you tied his readmission to his medication noncompliance. The confrontation sets the stage for the current hospitalization."
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A, C Therapeutic communication includes avoiding "why" questions and ensuring that verbal and nonverbal communication are congruent.
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A nurse is caring for a client who states, " I have to check with my wife and see if she thinks I am ready to be discharged." The nurse replies, " How do you feel about going home today?" Which clarifying technique is the nurse displaying to enhance communication between the nurse and the client? A. Pacing B. Reflecting C. Paraphrasing D. Restating
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B Reflecting directs the focus of the conversation back to the client so that the client can further explore his own feelings.
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A nurse is caring for a client who is concerned about being discharged home with a new colostomy because he is an avid swimmer. Which of the following statements made by the nurse indicates use of an effective communication technique? (select all that apply) A. "You will do great! You just have to get used to it." B. "Why are you so worried about going home?" C. "Your daily routines will be different when you get home." D. "Tell me about your support system when you leave the hospital." E. "Let me tell you about a friend of mine with a colostomy who also enjoys swimming."
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C, D, E C. Presenting reality is an effective communication technique that can help the client focus on what will really happen based on the changes that have occurred. D. Asking open-ended questions and offering general leads and broad opening statements are effective communication techniques that encourage the client to express feelings through dialogue and offer additional information. E. Offering self is an effective communication technique that can convey understanding and shared experience to the client. The focus should return to the client as soon as the relevant point is communicated.
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A nurse recognizes that a helping relationship is established with a client if the communication A. is equally reciprocal between the nurse and the client. B. encourages the client to express his thoughts and feelings. C. has no time limits. D. occurs spontaneously throughout the nurse-client relationship
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B Therapeutic communication facilitates a helping relationship that maximizes the client's ability to openly express his thoughts and feelings.
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A nurse is caring for a school-aged child who is seated. In order to facilitate effective communication, the nurse should A. touch the child B. sit at eye level with the child C. stand facing the child D. stand with a relaxed posture
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B The nurse should be at the same eye level as the child to facilitate communication.
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Which of the following are behaviors of active listening? (select all that apply) A. maintaining an open posture B. writing down what the client says so that details are not forgotten C. establishing and maintaining eye contact D. nodding in agreement with the client throughout the conversation E. responding positively when giving feedback
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A, C, E. having an open posture and leaning forward, establishing and maintaining eye contact, and responding positively when giving feedback are ways the nurse can demonstrate active listening.
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Which of the following is an example of a therapeutic communication technique? (Select all that apply.) A. Listening B. Restating C. Giving advice D. Reflecting E. Clarifying
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A, B, D, E Giving advice is nontherapeutic and can serve as a barrier to communicating with patients. The other listed techniques are considered to be therapeutic
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Which of the following is an example of a nontherapeutic communication technique? (Select all that apply.) A. Challenging B. Defending C. Focusing D. Paraphrasing E. Disapproving
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A, B, E Focusing and paraphrasing are therapeutic communication techniques. The other techniques are considered to be nontherapeutic
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Which statement demonstrates the most effective strategy for providing teaching to a depressed patient? A. Information is given to the patient in small amounts. B. Information is given to the patient in written form. C. Patients who are depressed do not benefit from health teaching. D. Patients who are depressed respond better to the NAP for health teaching.
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A When providing health teaching to a depressed patient, it is important to provide the information in small amounts, as patients with depression tend to have poor concentration and limited memory as symptoms of their condition. Consequently, giving too much information at a time may prove to be an ineffective strategy.
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You are the nurse assigned to care for a 4-year-old child who was involved in an automobile accident. She is withdrawn and is not communicating readily with the staff. What strategy can you use to interact with her? A. Ask her open-ended questions. B. Give her paper and crayons. C. Ask her family for help. D. Consult the staff psychologist.
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B When interacting with children, it is important to understand the child's developmental level and to select the most age-appropriate communication techniques. Drawing is an appropriate pre-reading communication technique for a 4-year-old child.
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A patient says, "I don't know if I'll make it through this surgery." Which response by the nurse may block further communication by the patient? 1. "You sound scared." 2. "You think you will die." 3. "Surgery can be frightening." 4. "Everything will be all right."
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1. This example of reflective technique identifies feelings, which promotes communication. 2. This example of paraphrasing restates the content of the patient's message, which promotes communication. 3. CORRECT: This response is false reassurance. It denies the patient's concerns about survival and does not invite the patient to elaborate. 4. This example of reflective technique focuses on feelings, which promotes communication.
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Which nursing action best reflects the concept of therapeutic communication? 1. Using interviewing skills to discuss the patient's concerns 2. Letting the patient control the focus of conversation 3. Setting time aside to talk with the patient 4. Agreeing with a patient's statements
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1. CORRECT: Therapeutic communication is patient centered and goal directed. It facilitates the exploration of the patient's thoughts and feelings and helps to establish a constructive relationship between the nurse and patient. 2. Although this often is done, there are many times when the patient may ramble and need to be refocused by the nurse. 3. Although this often is done, therapeutic communication can occur at any time, such as when providing physical hygiene or performing a procedure. 4. Although this often is done, there are many times when this response is inappropriate.
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The nurse is attempting to develop a helping relationship with a patient who was recently diagnosed with cancer. The nurse understands that a factor that is unique to this helping relationship is that it is: 1. Characterized by allowing the patient to assume the dominant role 2. Distinguished by an equal sharing of information 3. Specific to a person while guided by a purpose 4. Based on the needs of both participants
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1. There are times that the nurse must assume a dominant role; examples include when the patient is unconscious, out of touch with reality, in a crisis, or experiencing panic. 2. In a therapeutic relationship, the focus is on the patient, not the nurse. 3. CORRECT: The helping relationship (interpersonal relationship, therapeutic relationship) is a personal, client-focused, goal-oriented process in which the nurse assists a person in solving a problem and meeting a need. 4. The purpose of a therapeutic relationship is to focus on and meet the needs of the patient, not the nurse.
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The nurse must conduct a focused interview to complete an admission history. Which interviewing technique should the nurse use? 1. Probing 2. Clarification 3. Direct questions 4. Paraphrasing statements
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1. Probing questions violate the patient's privacy, may cut off communication, and are inappropriate even in a focused interview. Probing interviewing occurs when the nurse persistently attempts to obtain information even after the patient indicates an unwillingness to discuss the topic or pursues information out of curiosity, rather than because the information is significant. 2. Although clarification may be used during a focused interview to understand what the patient is saying, it is not the primary technique utilized for seeking specific information. 3. CORRECT: A focused interview explores a particular topic or obtains specific information. Direct questions meet these objectives and avoid extraneous information. 4. Paraphrasing may be used during a focused interview to redirect ideas back to the patient so that the patient can verify that the nurse received the message accurately or to allow the patient to hear what was said. However, it is not a technique that obtains specific information quickly.
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An agitated 80-year-old patient states, "I'm having trouble with my bowels." Which response by the nurse incorporates the interviewing skill of reflection? 1. "You seem distressed about your bowels." 2. "You're having trouble with your bowels?" 3. "It's common to have problems with the bowels at your age." 4. "When did you first notice having trouble with your bowels?"
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1. CORRECT: This response recognizes and reflects back the underlying feeling in the patient's message (reflective technique). When people consider themselves in trouble, they usually feel threatened or stressed. 2. This restates the patient's comment and is an example of paraphrasing, not reflection. 3. This negates the patient's concern and shuts off communication. 4. This is not an example of reflection; it is a direct question that collects specific information
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The nurse understands that the statement that is most accurate about communication is: 1. Communication is inevitable 2. Behavior clearly reflects feelings 3. Hands are the most expressive part of the body 4. Verbal communication is essential for human relationships
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1. CORRECT: Theory indicates that all behavior has meaning, people are always behaving, and we cannot stop behaving or communicating; therefore, communication is inevitable. 2. Behavior may imply, not clearly reflect, feelings. The nurse should obtain verbal feedback from the patient regarding assumptions about behavior. 3. The face, not the hands, is the most expressive part of the body. 4. All communication, not just verbal communication, is essential for human relationships
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The patient is extremely upset and mentions something about a work-related issue that the nurse cannot understand. What is the nurse's best response? 1. "It's natural to be worried about your job." 2. "Your job must be very important to you." 3. "Calm down so that I can understand what you are saying." 4. "I'm not quite sure I heard what you were saying about your work."
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1. This may or may not be an accurate assumption. 2. This makes an assumption that may be erroneous. 3. This patronizing response treats the patient in a condescending manner. The patient cannot calm down. 4. CORRECT: This response requests additional information in an attempt to clarify an unclear message.
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When providing nursing care, humor should be used to: 1. Diminish feelings of anger 2. Refocus the patient's attention 3. Maintain a balanced perspective 4. Delay dealing with the inevitable
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1. Humor used inappropriately can cause anger to be increased, suppressed, or repressed. Anger should be expressed safely. 2. The focus should be on the patient's concerns. 3. CORRECT: Humor is an interpersonal tool and a healing strategy. It releases physical and psychic energy, enhances wellbeing, reduces anxiety, increases pain tolerance, and places experiences within the context of life. 4. Coping strategies should not be delayed because delay increases stress and anxiety and prolongs the process.
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The nurse is conducting an admission interview with a patient. Which outcome identified by the nurse indicates that therapeutic communication is effective? 1. Verbal and nonverbal communication is congruent 2. Interaction is conducted in a professional manner 3. Common understanding is achieved 4. Thoughts can be put into words
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1. This just ensures that the message probably reflects the true feelings of the patient. 2. Interactions, even if conducted in a professional manner, may or may not be effective. 3. CORRECT: Understanding is the foundation of therapeutic communication. When the nurse comprehends, appreciates, and empathizes with the patient, therapeutic communication is effective. The working phase of the helping relationship can then move forward and is productive. 4. This just ensures that ideas or feelings are communicated. Sending a message is communication occurring in just one direction.
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A patient is admitted to the hospital with cirrhosis of the liver caused by long-term alcohol abuse. What is the best response by the nurse when the patient says, "I really don't believe that my drinking a couple of beers a day has anything to do with my liver problem?" 1. "How long have you been drinking several beers a day?" 2. "You find it hard to believe that beer can damage the liver." 3. "Each beer is equivalent to one shot of liquor so it's just as damaging to the liver as hard liquor." 4. "You may believe that beer is not harmful but research shows that it is just as bad for you as hard liquor."
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1. This response does not address the content or emotional theme of the patient's statement. In addition, this probing question may be a barrier to further communication. 2. CORRECT: This is an example of paraphrasing. It repeats the content in the patient's message in similar words to provide feedback to let the patient know whether the message was understood and to prompt further communication. 3. This response is confrontational, which may put the patient on the defensive and inhibit further communication. 4. This assertive, confronting, judgmental response will put the patient on the defensive and cut off communication.
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The patient states, "I can't believe that I couldn't even eat half my breakfast." Which statement by the nurse uses the interviewing skill of reflection? 1. "Let's talk about your inability to eat." 2. "What part of your breakfast were you able to eat?" 3. "How long have you been unable to eat most of your breakfast?" 4. "You seem surprised that you were unable to eat all your breakfast."
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1. This statement does not employ reflective technique. 2. This direct question elicits a minimal amount of information about only one aspect of eating. 3. This direct question focuses on just one aspect of the problem: duration. 4. CORRECT: This question is an example of reflective technique because it focuses on the feeling of surprise.
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What is the best response by the nurse when the patient's husband says, "I just don't know what to say to my wife if she asks how I feel about her breast cancer." 1. "How do you feel about your wife's diagnosis?" 2. "This is a difficult topic. However, let's talk about it." 3. "Do you think you could be as supportive as you can possibly be?" 4. "Men don't always understand what women are going through. Ask her about how she feels."
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1. This question is too direct. The husband may not be in touch with his feelings and will be unable to answer the question. 2. CORRECT: This response acknowledges that the husband is in a dilemma and it offers an opportunity to explore the situation. Validation and an invitation to talk provide emotional support, even if the opportunity to talk is declined. 3. This response focuses on the patient's needs and ignores the husband's concerns. 4. This response is condescending and focuses on the patient's, not the husband's, needs.
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What is being communicated when the nurse leans forward during a patient interview? 1. Privacy 2. Interest 3. Anxiety 4. Aggression
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1. Privacy is not reflected by leaning forward during an interview. Privacy is facilitated by pulling a patient's curtain or finding a separate room or quiet space to talk. 2. CORRECT: Leaning forward is a nonverbal behavior that conveys involvement. It is a form of physical attending, which is being present to another. 3. A closed posture, avoidance of eye contact, increased muscle tension, and increased motor activity convey anxiety. 4. Piercing eye contact, increased voice volume, challenging or confrontational conversation, invasion of personal space, and inappropriate touching convey aggression, which is a hostile, injurious, or destructive action or outlook.
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What best describes the following proverb? What you do speaks so loudly I cannot hear what you say. 1. Hearing ability is an important factor when communicating 2. Nonverbal messages are often more meaningful than words 3. Listening to what people say requires attention to what is being said 4. When people talk too loudly it is hard to understand what is being said
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1. Although hearing, one aspect of decoding a message, is an important factor in the communication process, it is unrelated to the stated proverb. 2. CORRECT: Nonverbal communication (body language) conveys messages without words and is under less conscious control than verbal statements. When a person's words and behavior are incongruent, nonverbal behavior most likely reflects the person's true feelings. 3. Although this true statement reflects active listening, it is unrelated to the stated proverb. 4. This statement is unrelated to the stated proverb. The volume of a message may or may not influence understanding of the message. The volume of a message occurs on the physiological level, whereas understanding a message occurs on the cognitive level
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A mother whose young daughter has died of leukemia is crying and is unable to talk about her feelings. What is the best response by the nurse? 1. "Everyone will remember her because she was so cute. She was one of our favorites." 2. "As hard as this is, it is probably for the best because she was in a lot of pain." 3. "She put up the good fight but now she is out of pain and in heaven." 4. "I feel so sad. It can be hard to deal with such a precious loss."
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1. This response is not therapeutic because it focuses on the nurse rather than on the mother. 2. The first part of this response minimizes the loss. The second part of the response focuses on the pain experienced by the child, which may increase the mother's grief. 3. This response minimizes the loss and focuses on the pain experienced by the child, which may increase the mother's grief. Also, the mother may not believe in heaven. 4. CORRECT: The first sentence communicates empathy. The second sentence focuses on the feelings surrounding loss and provides an opportunity for the patient to verbalize. Both of these are therapeutic responses to the situation.
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The goals of therapeutic communication mainly should depend on the: 1. Environment in which communication takes place 2. Role of the nurse in the particular clinical setting 3. Skill level of the nurse in the situation 4. Patient's verbalized concerns
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1. Although the environment may enhance or be a barrier to communication, it does not determine the goals of communication. 2. The role of a nurse in a particular setting does not dictate the goals of communication. 3. Although the interviewing skills of the nurse may determine the effectiveness of communication, it does not set the goals of communication. 4. CORRECT: The patient and significant others and their needs are always the focus of nursing interventions, including the goals of communication.
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A young adult who had a leg amputated because of trauma says, "No one will ever choose to love a person with one leg." What is the best response by the nurse? 1. "You are a good-looking person, and you will have no trouble meeting someone who cares." 2. "You may feel that way now, but you will feel differently as time passes." 3. "Do you feel that no one will marry you because you have one leg?" 4. "How do you see your situation at this point?"
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1. This negates the patient's concerns. The patient needs to focus on the "negative" before focusing on the "positive." In addition, only the future will tell if the patient meets someone who cares. 2. This is false reassurance. There is no way the nurse can ensure that this belief will change. 3. CORRECT: This is an example of paraphrasing, which restates the patient's message in similar words. It promotes communication. 4. This statement is unnecessary. The patient has already stated a point of view.
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The nurse is changing a patient's dressing over an abdominal wound. Which level of space around the patient is entered during the dressing change? 1. Public 2. Social 3. Intimate 4. Personal
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1. Touching is not used with public distance. Public space (12 feet and beyond) is effective for communicating with groups or the community. Individuality is lost. 2. Invasive touching does not occur with social distance. Social space (4 to 12 feet) is effective for more formal interactions or group conversations 3. CORRECT: Physically caring for a patient involves inspection and touch that invades the instinctual, protective distance immediately surrounding an individual. Intimate space (physical contact to 11/2 feet) is characterized by body contact and visual exposure. 4. "Laying on of the hands" does not occur with personal distance. Personal space (11/2 to 4 feet) is effective for communicating with another. It is close enough to imply caring and is not extended to the distance that implies lack of involvement.
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What stage of an interview establishes the relationship between the nurse and the patient? 1. Working stage 2. Opening stage 3. Surrogate stage 4. Examining stage
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1. This is not the purpose of the working stage. In the working stage, also called the body stage, of an interview patients communicate how they think, feel, know, and perceive in response to questions by the nurse. 2. CORRECT: The purposes of the opening stage of an interview are to establish rapport and orient the interviewee. A relationship is established through a process of creating goodwill and trust. The orientation focuses on explaining the purpose and nature of the interview and what is expected of the patient. 3. There is no stage called the surrogate stage in an interview. Hildegard Peplau identified six roles that nurses assume during therapeutic relationships, and one of these is the surrogate role. The nurse may be assigned a surrogate role by a patient to help resolve problems that need to be worked out in a supportive environment. 4. There is no stage called the examining stage in an interview. Examining takes place during a physical assessment, when specific skills are used to collect data systematically to identify health problems.
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The patient is exhibiting anxious behavior and states, "I just found out that I have cancer everywhere and I don't have very long to live. My life is over." What is the best response by the nurse? 1. "It might be good if your family were here right now. Shall I call them?" 2. "What might be the best way to approach this terrible news?" 3. "That is so sad. You must feel like crying." 4. "It sounds like you feel hopeless."
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1. This response abdicates the nurse's responsibility to explore the patient's concerns immediately. In addition, it could be an erroneous assumption. 2. The patient is in the shock and disbelief mode of coping and will not be able to explore approaches to coping. In addition, using the words "terrible news" may increase anxiety and hopelessness. 3. This response imposes the nurse's feelings and own coping skills into the situation. 4. CORRECT: This is an example of reflective technique. When no solutions to a problem are evident, a person becomes hopeless (i.e., despairing, despondent).
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Which interviewing skill is used when the nurse says, "You mentioned before that you are having a problem with your colostomy"? 1. Focusing 2. Clarifying 3. Paraphrasing 4. Acknowledging
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1. CORRECT: This example of focusing helps the patient explore a topic of importance. The nurse selects one topic for further discussion from among several topics presented by the patient. 2. This is not an example of clarifying, which lets the patient know that a message was unclear and seeks specific information to make the message clearer. 3. This is not an example of paraphrasing, which is restating the patient's message in similar words. 4. This is not an example of acknowledging, which is providing nonjudgmental recognition for a contribution to the conversation, a change in behavior, or an effort by the patient.
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The patient says, "I am really nervous about having a spinal tap tomorrow." What is the best response by the nurse? 1. "I'll ask the doctor for a little medication to help you relax." 2. "Patients who have had a spinal tap say it is not that uncomfortable." 3. "It's all right to be nervous, and I don't remember anyone who wasn't." 4. "The physician is excellent and is very careful when spinal taps are done."
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1. This statement avoids the patient's feelings and fails to respond to the patient's need to talk about concerns. It cuts off communication. 2. This is a generalization that minimizes the patient's concern and should be avoided. 3. CORRECT: This statement is therapeutic. It recognizes the patient's feelings, gives the patient permission to feel nervous, and reassures the patient that one's behavior is not unusual. This statement sets the groundwork for the next statement, such as, "Let's talk a little bit about the spinal tap and the concerns you may have." 4. This is false reassurance, which discourages discussion of feelings and should be avoided.
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A patient with chest pain is being admitted to the Emergency Department. When asked about next of kin the patient states, "Don't bother calling my daughter, she is always too busy." What is the best response by the nurse? 1. "She might be upset if you don't call her." 2. "What does your daughter do that makes her so busy?" 3. "Is there someone else that you would like me to call for you?" 4. "I can't imagine that your daughter wouldn't want to know that you are sick."
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1. This response will put the patient on the defensive and jeopardize the nurse-patient relationship. 2. This response requires the patient to rationalize the daughter's behavior and focuses on information that is not significant at this time. 3. CORRECT: This response lets the patient know that the message has been heard and moves forward to meet the need to notify a significant other of the patient's situation. 4. This provides false reassurance. Only the daughter can convey this message
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Which ability of the nurse is most important to achieve effective therapeutic communication? 1. Sending a verbal message 2. Using interviewing skills 3. Being assertive when collecting data 4. Displaying sympathy when communicating
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1. Communication involves both verbal and nonverbal messages. 2. CORRECT: Communication is facilitated by interviewing techniques that involve attitudes, behaviors, and verbal messages. Interviewing skills promote therapeutic communication because they are patient centered and goal directed. 3. Assertiveness when collecting data may be perceived by the patient as aggression, which is a barrier to communication. 4. A therapeutic relationship should avoid sympathy because it implies pity. The nurse should empathize, not sympathize, with patients
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What is the nurse doing when using the interviewing technique of active listening? 1. Identifying the patient's concerns and exploring them with why questions 2. Determining the content and feeling of the patient's message 3. Employing silence to encourage the patient to talk 4. Using nonverbal skills to display interest
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1. "Why" statements are direct questions that tend to put the patient on the defensive and cut off communication. 2. CORRECT: Active listening is the use of all the senses to comprehend and appreciate the patient's verbal and nonverbal thoughts and feelings. 3. Silence is passive, not active. Silence allows the patient time for quiet contemplation of what has been discussed. 4. When talking with patients, verbal and nonverbal cues are used to indicate care and concern, which promote communication.
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A patient who has had a number of postoperative complications appears upset and agitated, yet withdrawn. What is the most appropriate statement by the nurse? 1. "You seem agitated. Tell me why you are upset." 2. "You've been having a pretty rough time of it since surgery." 3. "It's not uncommon to have complications after the kind of surgery that you had." 4. "I'm not sure that I know everything that has been happening. Tell me what has happened to you since surgery."
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1. The first part of this statement uses the therapeutic interviewing technique of reflection, which identifies the underlying feelings of the patient and is appropriate. However, the second half of the statement is asking for an explanation, which is inappropriate. Patients often interpret why questions as accusations, which can cause resentment and mistrust and should be avoided. 2. CORRECT: This is an example of the therapeutic interviewing skill of an open-ended statement. It demonstrates that the nurse recognizes what the patient is going through, and the broad opening encourages free verbalization by the patient. At the very least it demonstrates caring and concern. 3. This statement minimizes the patient's feelings and is not supportive. 4. This statement will not inspire confidence in the nurse. Nurses should know what is happening if care is to be comprehensive and patient centered.
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The nurse is admitting a patient to the unit who was transferred from the Emergency Department. What should the nurse do to facilitate communication? 1. Ensure that the patient has an effective way to communicate with health-care team members 2. Use interviewing techniques to control the direction of the patient's communication 3. Minimize energy spent by the patient on negative feelings and concerns 4. Refocus to the positive aspects of the patient's situation and prognosis
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1. CORRECT: Communication between the patient and health-care providers is essential, particularly for obtaining subjective data and feedback. Speech, pantomime, writing, touch, and picture boards are examples of channels of transmission (e.g., mediums used to convey a message). 2. The patient, not the nurse, should direct the flow of communication. 3. Negative feelings or concerns must be addressed. Both physical and psychic energy are used when coping with stress. 4. The focus must be on the patient's present concerns before refocusing to other issues because anxiety increases if immediate concerns are not addressed. Focusing on the negative sometimes is necessary before focusing on the positive
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The nurse is caring for a confused patient with a diagnosis of dementia of the Alzheimer's type. What should the nurse say when assisting the patient to eat? 1. "Please eat your meat." 2. "It's important that you eat." 3. "What would you like to eat?" 4. "If you don't eat, you can't have dessert."
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1. CORRECT: Confused patients more easily understand simple words and sentences. 2. This may not be understood by the confused patient because the word important involves a conceptual thought. These patients respond better to concrete communication. 3. A confused patient may not be able to make a decision. 4. This is a threat and should be avoided when talking with patients. Also, it involves interpreting a "cause" and "effect" relationship.
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A patient states, "Do you think I could have cancer?" The nurse responds, "What did the doctor tell you?" What interviewing approach did the nurse use? 1. Paraphrasing 2. Confrontation 3. Reflective technique 4. Open-ended question
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1. The nurse's response is not an example of paraphrasing, which is restating the patient's basic message in similar words. 2. This is not an example of confrontation. A confronting or challenging statement fails to consider feelings, puts the patient on the defensive, and is a barrier to communication. 3. The nurse's response is not an example of reflective technique, which is referring back the basic feelings underlying the patient's statement. 4. CORRECT: This open-ended statement invites the patient to elaborate on the expressed thoughts with more than a one- or two-word response.
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A nurse is developing a therapeutic relationship with a patient with emotional needs. Which nursing interventions are essential during the working phase of the relationship? 1. Establish a formal or informal contract that addresses the patient's problems 2. Implement nursing interventions that are designed to achieve expected patient outcomes 3. Develop rapport and trust so the patient feels protected and an initial plan can be identified 4. Clearly identify the role of the nurse and establish the parameters of the professional relationship
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1. Formal or informal contracts are established during the introductory (orientation), not working, phase of a therapeutic relationship. 2. CORRECT: During the working phase of the therapeutic relationship nursing interventions have a twofold purpose: assisting patients to explore and understand their thoughts and feelings, and facilitating and supporting patient decisions and actions. 3. The development of trust is the primary goal of the introductory (orientation), not working, phase of a therapeutic relationship. Trust is achieved through respect, concern, credibility, and reliability. 4. These tasks are achieved during the introductory (orientation), not working, phase of a therapeutic relationship.
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The nurse uses reflective technique when communicating with an anxious patient. On what does the nurse focus when using reflective technique in this situation? 1. Feelings 2. Content themes 3. Clarification of information 4. Summarization of the topics discussed
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1. CORRECT: Reflective technique requires active listening to identify the underlying emotional concerns or feelings contained in patients' messages. These feelings are then referred back to patients to promote a clearer understanding of what they have said. 2. Content themes are referred back to patients through paraphrasing, which is a restatement of what was said in similar words. 3. When seeking clarification, the nurse can indicate confusion, restate the message, or ask the patient to elaborate in an attempt to make the patient's message more understood. 4. Summarization reviews the significant points of discussion to reiterate or clarify information.
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A patient says, "I don't know if I'll make it through this surgery." Which response by the nurse may block further communication by the patient? 1. "You sound scared." 2. "You think you will die." 3. "Everything will be all right." 4. "Surgery often can be frightening."
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1. This example of reflective technique identifies feelings, which promotes communication. 2. This example of paraphrasing restates the content of the patient's message, which promotes communication. 3. CORRECT: This response is false reassurance. It denies the patient's concerns about survival and does not invite the patient to elaborate. 4. This example of reflective technique focuses on feelings, which promotes communication.
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The patient states, "My wife is going to be very upset that my prostate surgery probably is going to leave me impotent." What is the best response by the nurse? 1. "I'm sure your wife will be willing to make this sacrifice in exchange for your well-being." 2. "The surgeons are getting great results with nerve-sparing surgery today." 3. "Your wife may not put as much emphasis on sex as you think." 4. "Let's talk about how you feel about this surgery."
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1. This response is false reassurance. Only the wife can make this statement. 2. Although a true statement, this response negates the patient's concerns and cuts off communication. 3. This may or may not be a true statement. Only the wife can make this statement. 4. CORRECT: The patient may be using projection to cope with the potential for impotence. This response indicates that it is acceptable to talk about sexuality and invites the patient to verbalize concerns.
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The patient states, "I think that I am dying." The nurse responds, "You feel as though you are dying?" What interviewing approach did the nurse use? 1. Focusing 2. Reflecting 3. Validating 4. Paraphrasing
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1. This is not an example of focusing, which centers on the key elements of the patient's message in an attempt to eliminate vagueness. It keeps a rambling conversation on target to explore the major concern. The patient was not rambling. 2. This is not an example of reflecting, which focuses on feelings. The use of the word "feel" does not make the nurse's statement an example of reflection. 3. This is not an example of validating. Consensual validation, a form of clarification, verifies the meaning of specific words rather than the overall meaning of the message. This ensures that both patient and nurse agree on the meaning of the words used. 4. CORRECT: The nurse's response is an example of paraphrasing because it uses similar words to restate the patient's message.
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The nurse plans to foster a therapeutic relationship with a patient. What is most important for the nurse to do? 1. Work on establishing a friendship with the patient 2. Use humor to defuse emotionally charged topics of discussion 3. Sympathize with the patient when the patient shares sad feelings 4. Demonstrate respect when discussing emotionally charged topics
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1. The nurse should maintain a professional relationship with the patient. Nurses may be "friendly" toward patients but should not establish a "friendship" with a patient. 2. Humor with emotionally charged issues may be viewed as minimizing concerns or frivolous and could be a barrier to communication. 3. Sympathy denotes pity, which should be avoided. The nurse should empathize, not sympathize, with the patient. 4. CORRECT: Emotionally charged topics should be approached with respectful, sincere interactions that are accepting and nonjudgmental, which will promote further verbalizations.
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A patient who is to receive nothing by mouth (NPO) in preparation for a bronchoscopy says, "I'm worried about the test and I can't even have a drink of water." What is the best response by the nurse? 1. "Let's talk about your concerns regarding the test." 2. "I'll see if the physician will let you have some ice chips." 3. "The physician will review the results of the test as soon as possible." 4. "As soon as the test is over I'll get you whatever you would like to drink."
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1. CORRECT: This response encourages the patient to explore concerns. Verbalization of concerns, validation of feelings, and patient teaching may help reduce anxiety. 2. This intervention bypasses data collection. In addition, ice chips are composed of water, which is contraindicated before and initially after a bronchoscopy because of the risk for aspiration. 3. This response ignores both of the patient's concerns and addresses a completely different issue. 4. Fluid and food are not permitted after a bronchoscopy until the gag reflex returns.
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A patient verbally communicates with the nurse while exhibiting nonverbal behavior. How should the nurse confirm the meaning of the nonverbal behavior? 1. Look for similarity in meaning between the patient's verbal and nonverbal behavior 2. Ask family members to help interpret the patient's behavior 3. Validate inferences by asking the patient direct questions 4. Recognize that what a patient says is most important
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1. CORRECT: The patient is the primary source of information. When nonverbal communication reinforces the verbal message, the message reflects the true feelings of the patient because nonverbal behavior is under less conscious control than verbal statements. 2. This abdicates the nurse's responsibility to others and obtains a response that is influenced by emotion and subjectivity. 3. Direct questions are too specific. Openended questions or gently pointing out the incongruence between actions and words are more effective techniques than direct questions in this situation. 4. Nonverbal behaviors, rather than verbal statements, better reflect true feelings. Actions speak louder than words!
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A patient appears tearful and is quiet and withdrawn. The nurse says, "You seem very sad today." What interviewing approach did the nurse use? 1. Examining 2. Reflecting 3. Clarifying 4. Orienting
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1. Examining is not an interviewing technique. 2. CORRECT. Reflective technique refers to feelings implied in the content of verbal communication or in exhibited nonverbal behaviors. Patients who are crying, quiet, and withdrawn often are sad. 3. This is not an example of clarifying, which is the use of a statement to better understand a message when communication is unclear, rambling, or garbled. 4. This is not an example of orienting. Reality orientation is a nursing technique used to assist patients in restoring an awareness of what is actual, authentic, or real.
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Which are the most important nursing actions when speaking with an older adult whose hearing is impaired? Select all that apply. 1. _____ Limit background noise 2. _____ Exaggerate lip movements 3. _____ Raise the pitch of your voice 4. _____ Stand directly in front of the patient when speaking 5. _____ Raise the volume of your voice while speaking directly toward the patient's good ear
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1. CORRECT: Limiting competing stimuli promotes reception of verbal messages. 2. This may be demeaning and ineffective because the patient may not be able to read lips. 3. This is not helpful. Hearing loss in the older adult typically involves a decreased perception of high-pitched sounds. 4. CORRECT: This focuses the patient's attention on the nurse. A hearing-impaired receiver must be aware that a message is being sent before the message can be received and decoded. 5. This is demeaning and may be viewed by the patient as aggressive behavior.
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A patient with a colostomy wants to learn how to irrigate a newly created colostomy. The nurse provides this teaching by developing a therapeutic nurse-patient relationship and implementing teaching strategies. Identify the statements that are included in the working phase of this therapeutic relationship. Select all those that apply. 1. _____ "How do you feel about doing this procedure?" 2. _____ "Would you like to try to insert the cone yourself today?" 3. _____ "You did a great job managing the instillation of fluid today." 4. _____ "I am here to help you learn how to irrigate your colostomy." 5. _____ "I'll arrange for a home care nurse to visit you in your home when you are discharged."
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1. This statement reflects the orientation phase of a therapeutic relationship. Although exploration of feelings is done throughout the phases, the primary goal of the orientation phase is the establishment of trust. Trust is promoted when the nurse focuses on the patient's emotional needs, is respectful, and individualizes care. 2. CORRECT: This statement reflects the working phase of a therapeutic relationship. It involves completing interventions that address expected outcomes, such as learning how to perform a colostomy irrigation. 3.CORRECT: This statement reflects the working phase of a therapeutic relationship. It includes providing feedback and encouragement. 4. This statement reflects the orientation phase of a therapeutic relationship. The nurse and patient make a verbal agreement to work together to assist the patient to achieve a goal. 5. This statement reflects the termination phase of a therapeutic relationship. It focuses on summarizing what has transpired and been accomplished and looks to the future.
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A nurse is collecting data for an admission nursing history. Which question by the nurse is best to open the discussion? 1. "What brought you to the hospital?" 2. "Would it help to discuss your feelings?" 3. "Do you want to talk about your concerns?" 4. "Would you like to talk about why you are here?"
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1. CORRECT: This is a focused open-ended statement that invites the patient to communicate while centering on the reason for seeking health care. 2. This direct question can be answered with a "yes" or "no" response. If the response is "no," then communication will be cut off. 3. This direct question can be answered with a "yes" or "no" response, which may limit communication. 4. The desire to talk and the need to talk are different issues. It is helpful if health-care providers collect as much significant data as possible.
