Chapter 08: Communication and the Nurse-Patient Relationship My Nursing Test Banks

Chapter 08: Communication and the Nurse-Patient Relationship

Test Bank

MULTIPLE CHOICE

1. The nurse can best ensure that communication is understood by:

a.

speaking slowly and clearly in the patients native language.

b.

asking the family members whether the patient understands.

c.

obtaining feedback from the patient that indicates accurate comprehension.

d.

checking for signs of hearing loss or aphasia before communicating.

ANS: C

The best way to determine understanding is to ask the patient. Factors such as anxiety, hearing acuity, language, aphasia, or lack of familiarity with medical jargon or routines can all contribute to misunderstanding.

DIF: Cognitive Level: Comprehension REF: pp. 100-101 OBJ: Theory #1

TOP: Feedback KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: basic care and comfort

2. The nurse recognizes a verbal response when the patient:

a.

nods her head when asked whether she wants juice.

b.

writes the answer to a question asked by the nurse.

c.

begins sobbing uncontrollably when asked about her daughter.

d.

is moaning and restless and appears to be in pain.

ANS: B

Verbal communication involves words, either written or spoken. Nodding, sobbing, and moaning are nonverbal communication.

DIF: Cognitive Level: Comprehension REF: p. 99 OBJ: Theory #1

TOP: Verbal Communication Feedback KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

3. The nurse recognizes the patient who demonstrates communication congruency when the patient:

a.

smiles and laughs while speaking of feeling lonely and depressed.

b.

wrings her hands and paces around the room while denying that she is upset.

c.

is tearful and slow in speech when talking about her husbands death.

d.

states she is comfortable while she frowns and her teeth are clenched.

ANS: C

Congruent communication is the agreement of verbal and nonverbal messages.

DIF: Cognitive Level: Comprehension REF: p. 99 OBJ: Theory #1

TOP: Congruence KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

4. A Hispanic patient approaches the Asian nurse and, standing very close, touches the nurses shoulder during their conversation. The nurse begins to step back to 18 to 24 inches, while smiling and nodding to the patient. This situation is most likely an example of:

a.

the nurses need to maintain a professional role rather than a social role.

b.

a patients attempt to keep the nurses attention.

c.

a nurses need to establish a more appropriate location for conversation.

d.

a difference in culturally learned personal space of the nurse and the patient.

ANS: D

Personal space between people is a culturally learned behavior; Asians, North American natives, and Northern European people generally prefer more personal space than people of Hispanic, Southern European, or Middle Eastern cultures.

DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: Theory #2

TOP: Cultural Differences KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

5. A nurse says to a patient, I am going to take your TPR, and then Ill check to see whether you can have a PRN analgesic. In considering factors that affect communication, the nurse has:

a.

used terminology to clearly inform the patient of what she is doing.

b.

given information that is unnecessary for the patient to know.

c.

used medical jargon, which might not be understood by the patient.

d.

taken into consideration the patients need to know what is happening.

ANS: C

Medical jargon such as abbreviations or medical terminology is often misunderstood, even by well-educated people.

DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #3

TOP: Blocks to Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

6. A nurse using active listening techniques would:

a.

use nonverbal cues such as leaning forward, focusing on the speakers face, and slightly nodding to indicate that the message has been heard.

b.

avoid the use of eye contact to allow the patient to express herself without feeling stared at or demeaned.

c.

anticipate what the speaker is trying to say and help the patient express herself when she has difficulty with finishing a sentence.

d.

ask probing questions to direct the conversation and obtain the information needed as efficiently as possible.

ANS: A

Eye contact is a culturally learned behavior and in some cases may not be appropriate. Probing questions or finishing the patients sentence is not part of active listening and is detrimental to an interview.

DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #3

TOP: Active Listening KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

7. When the patient says, I dont want to go home, the nurses best therapeutic verbal response would be:

a.

Im sure everything will be fine once you get home.

b.

You dont want to go home?

c.

Doesnt your family want you to come home?

d.

I felt like that when I had surgery last year.

ANS: B

The use of reflecting encourages the patient to expand on his or her feelings or thoughts.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Communication Techniques

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

8. To begin talking with a newly admitted patient about pain management, the nurse would most appropriately state:

a.

You look pretty comfortable. Are you having any pain?

b.

Tell me about the pain youve been having.

c.

Is this pain the same as the pain you had yesterday?

d.

Dont worry; this pain wont last forever.

ANS: B

An open-ended question allows the patient to express his or her feelings or needs.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Communication Techniques

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

9. When a patient begins crying during a conversation with the nurse about the patients upcoming surgery for possible malignancy, the nurses most therapeutic response would be:

a.

Your surgeon is excellent, and I know hell do a great job.

b.

Oh, dear, your gown is way too big, let me get you another one.

c.

Dont cry; think about something else and youll feel better.

d.

Here is a tissue. Id like to sit here for a while if you want to talk.

ANS: D

Offering self, or presence, and accepting a patients need to cry is supportive.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Therapeutic Techniques

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

10. To enhance the establishment of rapport with a patient, the nurse should:

a.

identify himself by name and title each time he introduces himself.

b.

share his own personal experiences so that the patient gets to know him as a friend.

c.

act in a trustworthy and reliable manner; respect the individuality of the patient.

d.

share information with the patient about other patients and why they are hospitalized.

ANS: C

Trust and reliability, as well as conveying respect for the individual, all promote rapport. Identifying oneself is important but in itself does not promote rapport. Sharing personal experiences or divulging the confidential nature of other patients conditions is not appropriate in the nursepatient relationship.

DIF: Cognitive Level: Comprehension REF: p. 107 OBJ: Clinical Practice #2

TOP: Rapport KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

11. The nurse explains that the therapeutic nursepatient relationship differs from the social relationship because:

a.

a social relationship does not have goals or needs to be met.

b.

the nursepatient relationship ends when the patient is discharged.

c.

the focus is mainly on the nurse in the nursepatient relationship.

d.

a social relationship does not require trust or sharing of life experiences.

ANS: B

The nursepatient relationship is limited to the patients stay in the facility and is focused on the patient. A social relationship may have goals or needs and does require trust and sharing of life experiences.

DIF: Cognitive Level: Comprehension REF: pp. 106-107 OBJ: Theory #4

TOP: Relationships KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

12. The nurse has selected an outcome for the patient to eat all of the food on the breakfast tray each day. Assessing that the patient has eaten all of the breakfast, the nurse would give positive feedback by saying:

a.

Wow! That breakfast must have been pretty good.

b.

I like pancakes too. Everyone on the hall seemed to enjoy them.

c.

I hope you can keep all that breakfast down.

d.

Hurray! You finished your whole meal! What would you like for tomorrow?

ANS: D

Giving positive feedback increases the likelihood of the desired behavior to be repeated. Commenting on the tastiness of the food or the fact that others liked it is not responding directly to the patients having eaten the whole meal.

DIF: Cognitive Level: Application REF: p. 100 OBJ: Theory #9

TOP: Positive Feedback KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

13. A 67-year-old woman had major abdominal surgery yesterday. She has IV lines, a urinary catheter, and an abdominal wound dressing, and she is receiving PRN pain medication. The end-of-shift report that best conveys the patient status is:

a.

Doing great, was up in the chair most of the day. No complaints of pain or discomfort. Voiding adequately.

b.

Abdominal surgery yesterday, dressing is dry and intact, her IVs are on time and shes had pain meds twice. Vital signs stable.

c.

Abdominal dressing dry, IVs800 mL left in #6; NS running at 125 mL/hr; urine output 800 mL this shift; had morphine 15 mg for pain at 8:00 AM and at 1:30 PM. Shes comfortable now. Vital signs are stable, no fever.

d.

Unchanged since this morning. She wanted to know how soon she can have something to eat, so maybe you could check with her doctor this evening. Her husband has been visiting all day and will let you know if she needs anything.

ANS: C

This brief clear report addresses the major concerns of the abdominal dressing, the status of the IV fluids, vital signs, and analgesia needs.

DIF: Cognitive Level: Application REF: pp. 109-110 OBJ: Clinical Practice #4

TOP: Shift Report KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

14. An aspect of computer use in patient care in which the LPN may need to be proficient includes:

a.

input of data such as requests for radiographs or laboratory services.

b.

programming the computer to record data from physicians and other health care workers.

c.

teaching patients how to use hospital computers to access information such as discharge instructions or information relative to specific medications.

d.

scheduling admissions, discharges, and nurse staffing to keep the unit at the best occupancy and utilization.

ANS: A

Many facilities use computers for data entry relative to requesting radiograph or lab services and physical assessment and medication administration. Programming such computers is not a nursing task, and patients need to have individualized information about discharge and medications.

DIF: Cognitive Level: Knowledge REF: pp. 110-111 OBJ: Theory #8

TOP: Computer Use KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

15. A patient with a nursing diagnosis of Sensory perception, disturbed auditory, would most appropriately require the nurse to:

a.

obtain a sign language interpreter when a family member is unavailable.

b.

speak slowly and distinctly, but not shout.

c.

provide bright lighting without glare and orient frequently.

d.

reorient frequently to time, place, staff, and events.

ANS: B

A patient with disturbed auditory perception cannot hear well (or at all); therefore, speaking slowly and distinctly without shouting increases patient comprehension.

DIF: Cognitive Level: Application REF: pp. 107-108 OBJ: Clinical Practice #3

TOP: Hearing-Impaired Patient Communication

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

16. When an office nurse asks the patient to repeat information that he has just given to the patient over the telephone, the nurse is:

a.

testing the patients intelligence and memory.

b.

acting in a cautious way to avoid charges of negligence.

c.

verifying that the patient understands the information.

d.

saving the extra time it would take to mail the information.

ANS: C

Obtaining feedback from a patient to ascertain that the patient understands instructions is an important part of the communication process, especially over the phone, when the nurse does not have nonverbal cues.

DIF: Cognitive Level: Comprehension REF: pp. 100-101 OBJ: Theory #3

TOP: Telephonic Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

17. A 36-year-old woman who is in traction for a fractured femur that she received in an auto accident is found crying quietly. The nurse can best address this situation by saying:

a.

Whats the matter? Why are you crying? Are you in pain?

b.

Stop crying and tell me what your problem is.

c.

This could have been much worse. Youre lucky no one was killed.

d.

You are upset. Can you tell me whats wrong?

ANS: D

The nurse offers a general lead as to what is causing the distress. The other options are judgmental or clichs or offer no opportunity for the patient to express feelings.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Reflecting Observations

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

18. When the nurse is giving direction to a nursing assistant who is being delegated part of the patient care, the nurses most effective direction would be:

a.

Do the morning care first on the patients in 205 and 206 who cant get out of bed.

b.

You take care of all the patients in 205 and 206. Let me know how youre doing and whether you need any help.

c.

Give the patient in 204A a shower after breakfast, and call me to check her feet before you get her dressed.

d.

Take the vital signs on all the patients in the lounge and tell me whether there are problems.

ANS: C

The clarity and brevity of the direction makes the delegated task clear and leaves the responsibility of assessment to the nurse.

DIF: Cognitive Level: Application REF: p. 110 OBJ: Theory #7

TOP: Delegation KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

19. When the patient says, I get so anxious just lying here in this hospital bed. I have a million things I should be doing at home, the most empathetic response would be:

a.

Id feel the same way you do. I know just what youre going through.

b.

It sounds like youre having a tough time dealing with this situation.

c.

Its always darkest before the dawn. Hang in there; it will get better.

d.

You sound pretty sorry for yourself. Why dont you look at the positives?

ANS: B

Empathy recognizes a patients situation and encourages expression of feelings.

DIF: Cognitive Level: Application REF: p. 107 OBJ: Theory #3

TOP: Empathy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

20. A patient asks the nurse, What would you do if you had cancer and had to choose between surgery and chemotherapy? The reply that can best help the patient is:

a.

If I were you, I would choose surgery and then consider chemo afterward.

b.

What solutions have you considered?

c.

I would talk it over with my friends first.

d.

I dont know. Im glad it isnt my decision.

ANS: B

Nurses can help by reminding patients of alternatives open to them and should refrain from giving advice but can encourage the patient to consider options. The nurse may be glad not to face a decision a patient must, but it is not helpful to the patient to say this.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Offering Alternatives

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. The nurse chooses to use touch in the nursepatient relationship because touch:

a.

can convey caring and support when words are difficult.

b.

should be avoided because of problems of cultural misinterpretation.

c.

is appropriate only in special circumstances, such as with young children.

d.

is a nursing intervention of choice in almost all situations.

ANS: A

Touch is a powerful and supportive nonverbal communication in many situations. It is appropriate for all ages, but not in some situations. Careful assessment of the patients situation and cultural values should determine its use, but it should not be avoided because of stereotypes.

DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #4

TOP: Caring Touch KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

22. When the nurse makes the statement, We can come back to that laterright now I need to know about when your symptoms started, the nurse is:

a.

letting the patient know that topic of conversation was inappropriate.

b.

setting limits on the expression of feelings.

c.

refocusing the patient to the issue at hand when the conversation has wandered.

d.

closing off the conversation by quickly getting to the point of the interview.

ANS: C

Refocusing is often necessary to accomplish data collection. It does not block communication and is not used to close a conversation or stop an inappropriate topic.

DIF: Cognitive Level: Comprehension REF: p. 102 OBJ: Theory #3

TOP: Refocusing Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

23. A patient who has had a stroke is unable to speak clearly and has right-sided hemiplegia. The nurse will design the approach to the assessment interview by:

a.

asking questions and explaining procedures to the patients daughter.

b.

speaking slowly and giving the patient time to respond.

c.

telling the patient he will get all necessary information from the daughter.

d.

prompting the answers and finishing the sentences for the patient.

ANS: B

Speaking slowly recognizes that the patient may process (if able) information more slowly.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Clinical Practice #3 TOP: Impaired Communication

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

24. When a nurse is conducting an assessment interview, the most efficient technique would be:

a.

explaining the purpose of the interview.

b.

excluding relatives and friends from the interaction.

c.

telling the patient what data are already available.

d.

asking closed questions to obtain essential information.

ANS: D

Closed questions have a definite place when the nurse wants to obtain specific essential data. Closed questions force the patient to stick to the topic.

DIF: Cognitive Level: Comprehension REF: p. 102 OBJ: Clinical Practice #1

TOP: Interview KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

25. While interviewing a Native American man for the admission history, the nurse should expect to:

a.

wait patiently through long pauses in the conversation.

b.

maintain eye contact with the patient.

c.

give the patient permission to speak.

d.

have another family member speak for the patient.

ANS: A

Native Americans use long pauses in their conversation to better consider their answer and consider the question. The culturally sensitive nurse would wait quietly through the pauses.

DIF: Cognitive Level: Comprehension REF: p. 102 OBJ: Clinical Practice #1

TOP: Cultural Considerations KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

26. The nurse is aware that the purpose of therapeutic communication is to:

a.

gather as much information as possible about the patients problem.

b.

direct the patient to communicate about his deepest concerns.

c.

focus on the patient and the patient needs to facilitate interaction.

d.

gain specific medical information and history of illness.

ANS: C

Therapeutic communication is a conversation that is focused on the patient and promotes understanding between the sender and the receiver.

DIF: Cognitive Level: Comprehension REF: p. 102 OBJ: Theory #4

TOP: Therapeutic Communication KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

27. The practical nursing student who is engaged in a therapeutic communication with a patient will have the most difficulty with the technique of:

a.

closed questions.

b.

restating.

c.

using general leads.

d.

silence.

ANS: D

The use of silence is the hardest for most students to develop because it makes them uncomfortable, so they tend to end it prematurely.

DIF: Cognitive Level: Comprehension REF: p. 102 OBJ: Theory #31

TOP: Silence KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

28. To convey the intervention of active listening, the nurse would:

a.

maintain eye contact by staring at the patient.

b.

prompt the patient when the patient stops talking for a moment.

c.

make a conscious effort to block out other sounds in the immediate environment.

d.

write down remarks on a clipboard to facilitate later topics of conversation.

ANS: C

An active listener maintains eye contact without staring, gives the patient full attention, and makes a conscious effort to block out other sounds and distractions.

DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #3

TOP: Active Listening KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

29. When the nurse enters the room, the patient is laughing out loud at something on TV. The patient stops and apologizes for the laughter, saying, I guess I ought not be laughing at all since I am stuck here with two broken legs. The nurse can use evidence-based information when she responds:

a.

Laughter is nearly always a cover-up for anxiety when facing a long rehabilitation.

b.

Long periods of laughter decrease the amount of oxygen available to your body for healing.

c.

Laughter in a hospital is often distracting and depressing to other patients nearby.

d.

Laughter truly is the best medicine as it has a positive effect on the immune system.

ANS: D

Hasen and Hasen (2009) found that laughter and appropriate use of humor decreased stress and anxiety and had a positive effect on the immune system.

DIF: Cognitive Level: Application REF: p. 101 OBJ: Clinical Practice #2

TOP: Use of Laughter KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

30. When interacting with an elderly patient, the nurse would enhance communication by:

a.

speaking slowly in order to allow the patient to process the message.

b.

addressing him by his first name to encourage a therapeutic relationship.

c.

standing in the doorway rather than entering the room to give the elderly patient more privacy.

d.

speaking in simple sentences, as if to a child.

ANS: A

When interacting with an elderly person, the nurse should try not to speak too quickly or expect an immediate answer because the elderly take more time to process the message. Do not use baby talk or speak to them as if they were children.

DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #2

TOP: Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

31. When the nurse observes a resident in a long-term facility pounding his fists on his legs and grinding his teeth, the nurse will validate her perception of the patients non-verbal expression of anger by:

a.

documenting that the patient was agitated and appeared angry.

b.

asking the male nursing assistant if it is his perception that the patient appears angry.

c.

accessing the nursing care plan to ascertain if there is a nursing diagnosis relative to anger.

d.

sitting down near the patient and saying, You seem upsetcan I help?

ANS: D

All perceptions based on the observation of non-verbal behavior should be validated by consulting the patient.

DIF: Cognitive Level: Application REF: p. 100 OBJ: Theory #9

TOP: Validating Perceptions

KEY: Nursing Process Step: Assessment | Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

32. When a patient states, I dont feel like walking today, the nurses most therapeutic verbal response would be:

a.

You have to walk today.

b.

You dont want to walk today?

c.

I dont feel like walking today either.

d.

Why dont you want to walk today?

ANS: B

Reflection is a way to restate the message. The idea is simply reflected back to the speaker in a statement to encourage continued dialogue on the topic.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Communication Techniques

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

33. When a patient states, My son hasnt been to see me in months, the nurses best verbal response is:

a.

Dont worry; Im sure your son will visit.

b.

Your son hasnt been around much lately?

c.

My son doesnt come to visit me either.

d.

How terrible that he doesnt visit you.

ANS: B

Restating in different words what the patient said encourages further communication on that topic.

DIF: Cognitive Level: Application REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Communication Techniques

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

34. An example of a nurse communicating with a patient using open-ended questions would be:

a.

Is your pain less today than it was yesterday?

b.

Did you sleep all night without waking?

c.

How many bowel movements have you had today?

d.

What was your daughters reaction to your desire for hospice?

ANS: D

An open-ended question is broad, indicating only the topic, and it requires an answer of more than a word or two. Use of an open-ended question or statement allows the patient to elaborate on a subject or to choose aspects of the subject to be discussed. Open-ended questions or statements are helpful to open up the conversation or to proceed to a new topic. They usually cannot be answered with one word or just yes or no.

DIF: Cognitive Level: Comprehension REF: p. 103, Table 8-1

OBJ: Theory #3 TOP: Communication Techniques

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

35. The nurse tells a patient, For the last 2 days we have talked about whether to notify your daughter of your upcoming surgery in 2 days. You have indicated you do not want to be a burden to her, but you also would like to have her here. You may have to decide rather quickly because of the time constraint. The nurse is using the technique of:

a.

focusing.

b.

reflection.

c.

restatement.

d.

summarizing.

ANS: D

Summarizing presents the problem and possible solutions with the attendant difficulties. This technique unclutters the problem and presents it back to the patient for his or her choice of a solution.

DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: Theory #3

TOP: Communication Techniques KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

36. The nurse is caring for a patient who states, I tossed and turned last night. The nurse responds to the patient, You feel like you were awake all night? This is an example of:

a.

an open-ended question.

b.

restatement.

c.

reflection.

d.

offering self.

ANS: B

Restatement is a therapeutic communication technique in which the nurse restates in different words what the patient said. This encourages further communication on that topic.

DIF: Cognitive Level: Comprehension REF: pp. 102-103 OBJ: Theory #3

TOP: Restatement KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

37. The nurse is caring for a patient who has just had a mastectomy (breast removal). The patient expresses concern that her husband will no longer find her attractive because of her mastectomy. The nurse appropriately responds:

a.

Youre concerned your husband will find you unattractive because of your mastectomy?

b.

Youre a beautiful woman; of course your husband will find you attractive after your mastectomy.

c.

Dont worry; when I had my mastectomy, my husband still found me very attractive.

d.

You should leave your husband immediately if he thinks youre unattractive after a mastectomy.

ANS: A

This is an example of restatement, which allows the patient to know her message was understood and encourages the patient to continue about her concerns on the topic.

DIF: Cognitive Level: Application REF: pp. 102-103 OBJ: Theory #3

TOP: Restatement/Reflection KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

38. A patient states, Im so worried that I might have cancer. The nurse responds, It is time for you to eat breakfast. The nurses response is an example of:

a.

using clichs.

b.

judgmental response.

c.

changing the subject.

d.

giving false reassurance.

ANS: C

Changing the subject is a block to effective communication in which the patient is deprived of the chance to verbalize concerns.

DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: Theory #3

TOP: Changing the Subject KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

39. The nurse is aware that the use of false reassurance is harmful to the nursepatient relationship, because this communication block:

a.

discounts the patients stated concerns.

b.

shows a judgmental attitude on the part of the nurse.

c.

summarizes the patients concerns and closes communication.

d.

confuses the patient by giving information.

ANS: A

Giving false reassurance is a block to effective communication in which the patients feelings are negated and in which the patient may be given false hope, which, if things turn out differently, can destroy trust in the nurse.

DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: Theory #3

TOP: False Reassurance KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

40. A home health patient with a bleeding ulcer informs the nurse that she ate a bowl of chili with jalapenos. An inappropriate communication block with a judgmental tone by the nurse would be:

a.

Well, you have had this problem long enough to know what will happenyou certainly cant blame me!

b.

I dont think that was a smart thing for you to do considering your ulcer.

c.

Well, you better watch your stool for evidence of blood so you can notify your physician.

d.

Oh, poo! A bowl of chili every now and then wont make a lot of difference to your ulcer.

ANS: B

Judgmental response is a block to effective communication in which the nurse is judging the patients action. It implies that the patient must take on the nurses values and is demeaning to the patient.

DIF: Cognitive Level: Analysis REF: p. 105, Table 8-2

OBJ: Theory #3 TOP: Judgmental Response

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

41. A patient tells the nurse that she dislikes the food that is served in the hospital. The nurse responds, Our cooks work very hard; the food that is served is very good. The nurses response is an example of the communication block of:

a.

judgmental response.

b.

giving advice.

c.

defensive response.

d.

using clichs.

ANS: C

Defensive response is a block to effective communication in which the nurse responds by defending the hospital food. This prevents the patient from feeling that she is free to express her feelings.

DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: Theory #3

TOP: Defensive Response KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

42. A nurse caring for a patient who fell off the roof while he was intoxicated asks the patient, Why in the world were you on the roof when you had been drinking? The nurses statement is an example of which type of communication?

a.

Changing the subject

b.

Defensive response

c.

Inattentive listening

d.

Asking probing questions

ANS: D

Asking probing questions is a block to effective communication in which the nurse pries into the patients motives and therefore invades privacy.

DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: Theory #3

TOP: Probing KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

43. The nurse caring for a patient who is concerned about her 10-pound weight loss relative to her chemotherapy tells the patient, Lucky you! Every cloud has a silver lining. The nurses statement is an example of which type of communication block?

a.

Defensive response

b.

Asking probing questions

c.

Using clichs

d.

Changing the subject

ANS: C

Using clichs is a block to effective communication in which the patients individual situation is negated, and the patient is stereotyped. This type of response sounds flippant and prevents the building of trust between the patient and the nurse.

DIF: Cognitive Level: Comprehension REF: pp. 105-106 OBJ: Theory #3

TOP: Clichs KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

44. The nurse is caring for a patient with a diagnosis of lung cancer. The nurse states, If I were you, I would have radiation therapy. The nurses statement is an example of which type of communication block?

a.

Inattentive listening

b.

Giving advice

c.

Using clichs

d.

Defensive response

ANS: B

Giving advice is a block to effective communication and tends to be controlling and diminishes patients responsibility for taking charge of their own health.

DIF: Cognitive Level: Comprehension REF: p. 105, Table 8-2

OBJ: Theory #3 TOP: Giving Advice

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

45. The nurse is caring for a patient who is concerned about living alone. The best response by the nurse is:

a.

Where have you considered living?

b.

Why dont you live with your family?

c.

I think you should live with your family.

d.

If you were my mom, Id have you live with me.

ANS: A

Rephrasing will help the patient explore various alternatives. The nurse should not use phrases such as Why dont you, When that happened to me, I did, or I think you should. Rephrasing, for example, Have you thought of your options? or You might want to think about, or Have you considered? will help the patient explore various alternatives.

DIF: Cognitive Level: Application REF: p. 104 OBJ: Theory #3

TOP: Offering Alternatives KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

46. The characteristic that is representative of the nursepatient relationship is that this relationship:

a.

focuses on the nurses ability to build rapport.

b.

continues after discharge.

c.

does not include humor.

d.

focuses on the assessed patient health problems.

ANS: D

The nursepatient relationship focuses on the patient, has goals, and is defined by specific boundaries. The relationship takes place in the health care setting, and boundaries are defined by the patients problems, the help needed, and the nurses professional role. When the patient is discharged, the relationship ends.

DIF: Cognitive Level: Knowledge REF: pp. 106-107 OBJ: Theory #4

TOP: NursePatient Relationship KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

47. When communicating with an aphasic patient, the nurse appropriately:

a.

speaks quickly and shouts so the patient can hear.

b.

assumes the patient can understand what is heard.

c.

speaks to the patients caregiver about the patient.

d.

assumes the patient cannot understand what is heard.

ANS: B

When communicating with an aphasic patient, the nurse assumes the patient can understand what is heard even though speech is jargon or the person is mute, unless deafness has been diagnosed. The nurse should talk to the patient, and not talk to someone else in the room about the patient. The nurse should speak slowly and distinctly and should not shout.

DIF: Cognitive Level: Comprehension REF: p. 108, Box 8-1

OBJ: Clinical Practice #3 TOP: Impaired Communication

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

48. When communicating with a hearing-impaired patient, the nurse appropriately:

a.

shouts repeatedly at the patient.

b.

speaks directly into the patients ear.

c.

uses long, complex sentences.

d.

uses short, simple sentences.

ANS: D

When communicating with a hearing-impaired patient, the nurse appropriately uses short, simple sentences. The nurse should not shout because this can distort speech and does not make the message any clearer. The nurse should never speak directly into the persons ear. This can distort the message and hide all visual cues.

DIF: Cognitive Level: Comprehension REF: p. 108, Box 8-1

OBJ: Clinical Practice #3 TOP: Impaired Communication

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

49. When communicating with a preschooler, the nurse should:

a.

use abstract explanations.

b.

use unfamiliar language.

c.

use long, complex sentences.

d.

consider the developmental level, using familiar words.

ANS: D

When interacting with a toddler or a preschooler, the nurse should focus on the childs needs and concerns. The nurse should also use simple, short sentences and concrete explanations with familiar words.

DIF: Cognitive Level: Comprehension REF: p. 109 OBJ: Clinical Practice #3

TOP: Communication with Children KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

50. When communicating with an adolescent, the nurse should be very sensitive to avoid:

a.

asking embarrassing questions.

b.

offering advice.

c.

interrupting frequently.

d.

using active listening.

ANS: C

An adolescent needs time to talk. The nurse should use active listening, avoid interrupting, and show acceptance. The nurse should try not to give advice.

DIF: Cognitive Level: Comprehension REF: p. 109 OBJ: Clinical Practice #3

TOP: Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

51. The physician informs the student nurse that he would like to give a telephone order. The best response by the student is:

a.

document the telephone order on the physicians orders.

b.

ask another student to listen as a witness to the telephone order.

c.

tape-record the physician giving the order to the student nurse.

d.

ask the registered nurse to take the telephone order.

ANS: D

The student nurse should have an instructor or another registered nurse standing by to take the new orders from the physician because students cannot legally take telephone orders.

DIF: Cognitive Level: Application REF: p. 110 OBJ: Theory #6

TOP: Telephone Orders KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

52. A nurse is delegating to a nursing assistant. The most appropriate form of this type of communication would be:

a.

Let me know if Mr. Jones temperature is high.

b.

I need to know if Mr. Jones blood pressure is elevated.

c.

Come and get me if Mr. Jones has a high heart rate.

d.

If Mr. Jones heart rate is greater than 100, let me know.

ANS: D

It is important to communicate well in order to assign tasks and delegate to others effectively. The nurse should give clear, concise messages that include the desired results.

DIF: Cognitive Level: Comprehension REF: p. 110 OBJ: Theory #7

TOP: Delegation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

53. In order to safeguard patient information when using a computer, the nurse should:

a.

only use the computer located in the nurses station.

b.

wait until the end of the shift and chart all information at one time.

c.

use personal code words and abbreviations to disguise information.

d.

change the computer password frequently.

ANS: D

Computerized patient information requires extra vigilance by the nurse to safeguard confidentiality. Changing personal passwords frequently helps safeguard information. When using the computer at a health care facility, the nurse must remember not to leave a computer screen open when he or she is finished. The nurse should always log out so that someone else cannot access information using his or her password and must not share his or her password with others. Computers in the nurses station are not as convenient as those at the bedside or in the hall. Personal codes and abbreviations are not useful.

DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: Theory #8

TOP: Patient Information Safety KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

COMPLETION

54. Pain is often conveyed through non-verbal communication. Two other common, non-verbally expressed emotions are _____ and _____.

ANS:

anxiety; fear

fear; anxiety

Anxiety and fear can be expressed non-verbally by such behaviors as restlessness and picking at the bed covers.

DIF: Cognitive Level: Knowledge REF: p. 100 OBJ: Theory #1

TOP: Nonverbal Communication KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: basic care and comfort

55. To elicit more information from a patient, the nurse should ask questions that require more than a one-word answer. This type of question is called __________.

ANS:

open-ended

Open-ended questions provide more information than can be gathered from closed questions.

DIF: Cognitive Level: Knowledge REF: p. 102 OBJ: Theory #1

TOP: Open-Ended Questions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

56. The communication technique of __________ gives the caregiver the opportunity to ask and respond to questions.

ANS:

ISBAR-R

ISBAR-R format allows the opportunity to ask and respond to questions concerning patient care during the end of shift report. The initials stand for introduction, situation, background, assessment, recommendation, and readback.

DIF: Cognitive Level: Comprehension REF: p. 110 OBJ: Theory #9

TOP: ISBAR-R KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

MULTIPLE RESPONSE

57. The nurse is alert to avoid using blocks to effective communication that include: (Select all that apply.)

a.

changing the subject.

b.

using non-judgmental remarks.

c.

giving advice.

d.

asking probing questions.

e.

offering hope.

f.

using clichs.

ANS: A, C, D, F

Such behavior as changing the subject, giving advice, asking probing questions that probe into a patients motive, and using clichs all block communication. Offering hope and giving remarks that are non-judgmental are appropriate forms of communication.

DIF: Cognitive Level: Comprehension REF: pp. 104-106 OBJ: Theory #3

TOP: Effective Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

58. During the initial interview of a patient, the nurse should: (Select all that apply.)

a.

assess the language capabilities of the patient.

b.

use open-ended questions.

c.

limit the interview to approximately 30 minutes.

d.

assess comprehension abilities of the patient.

e.

make the patient as comfortable as possible.

f.

obtain the patients medical history from the physician.

ANS: A, C, D, E

During the initial assessment, the patient should be comfortable and the nurse should ask closed questions to elicit specific information. The interview should last approximately 30 minutes, and the nurse needs to evaluate the language and comprehension skills of the patient to ensure effective communication.

DIF: Cognitive Level: Comprehension REF: pp. 107-108 OBJ: Clinical Practice #1

TOP: Interview Skills KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

59. When using the telephone to communicate with a physician about a patient, the student nurse should have ready: (Select all that apply.)

a.

current information relative to patients condition change.

b.

assessment of vital signs.

c.

information on urinary output.

d.

patients social security number or hospital identification number.

e.

medications received.

ANS: A, B, C, E

As a rule the physician does not need to have the social security number or the hospital identification number, but does need information on the patients condition, vital signs, urinary output, and medications received.

DIF: Cognitive Level: Comprehension REF: p. 110 OBJ: Theory #6

TOP: Telephone Communication with a Physician

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

60. The nurse will appropriately and deliberately use the closed question technique when the patient is: (Select all that apply.)

a.

being asked for specific information.

b.

extremely anxious and unfocused.

c.

having difficulty expressing feelings.

d.

confused.

e.

angry and ranting about his lack of medical care.

ANS: A, B, D

Closed questions are useful for gaining specific information such as age, address, and listing of allergies. Closed questions help the anxious, confused, and unfocused patient to respond. Patients who are having difficulty expressing feelings are not aided by closed questions. Angry patients need to be helped by silence or general leads.

DIF: Cognitive Level: Application REF: p. 102 OBJ: Theory #3

TOP: Closed Questions KEY: Nursing Process Step: Intervention

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

61. Behaviors that indicate to the patient that the nurse is inattentive to the patients concerns are such activities as: (Select all that apply.)

a.

turning back to straighten the bedside table while the patient is talking.

b.

tapping feet or fingers.

c.

sitting down in a chair near the bed with arms crossed.

d.

leaving a hand on the door to go out.

e.

nodding and asking for elaboration.

ANS: A, B, C, D

Turning from the patient, tapping the feet or fingers, sitting with arms crossed, and leaving the patient all indicate to the patient that his or her concerns are not important and the information is boring to the nurse. Nodding and asking for elaboration indicate that the nurse is attentive and focused on his or her concerns.

DIF: Cognitive Level: Analysis REF: p. 105, Table 8-2

OBJ: Theory #3 TOP: Inattentive Listening

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

One comment

Leave a Reply