Chapter 13: Straightforward Communication: Instructors, Coworkers, and Patients My Nursing Test Banks

Chapter 13: Straightforward Communication: Instructors, Coworkers, and Patients

Test Bank

MULTIPLE CHOICE

1. A trusting relationship with a patient can be fostered by

a.

introducing oneself and stating ones role.

b.

identifying the patient by room number.

c.

seeing the patient every 5 to 7 minutes.

d.

making up answers when one does not know the answer.

ANS: A

Trust begins by gaining the patients confidence through introducing oneself and stating ones role. Identifying the patient by room number depersonalizes the patient. Seeing the patient every 5 to 7 minutes would be excessive in most situations. Making up answers when one does not know the answer is dishonest.

DIF: Cognitive Level: Application REF: p. 150|p. 154

OBJ: 9 TOP: Trust KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

2. A patient is crying. The nurse can correctly conclude from this type of nonverbal communication that the

a.

patient is sad.

b.

tears reflect happiness.

c.

patient is in pain.

d.

situation needs clarification.

ANS: D

The reason for the patients crying cannot be determined on the basis of the data supplied. The patient could be sad, happy, or in pain. The situation needs clarification.

DIF: Cognitive Level: Analysis REF: p. 151 OBJ: 2

TOP: Communication

KEY: Nursing Process Step: Assessment (Data Collection)

MSC: NCLEX: Physiological Integrity

3. The nurse who demonstrates empathy

a.

feels sorry for the patients situation.

b.

understands the patients thoughts but is unaware of his or her feelings and emotions.

c.

understands and appreciates the patients feelings while remaining objective.

d.

attempts to remove physical and emotional pain and fix all of the patients problems.

ANS: C

Empathy is the ability to understand and appreciate what someone else is feeling without actually experiencing the emotion itself. This permits the nurse to remain objective. Feeling sorry for the patients situation suggests sympathy rather than empathy. Understanding the patients thoughts but being unaware of his or her feelings and emotions speaks of a nurse who lacks awareness of others emotions. Attempts to remove physical and emotional pain and fix all of the patients problems suggests overinvolvement.

DIF: Cognitive Level: Application REF: p. 155 OBJ: 9

TOP: Empathy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

4. The nurse demonstrates commitment to the patient by

a.

delivering nursing care skillfully.

b.

using humor to poke fun at the patient.

c.

giving advice to solve the patients problems.

d.

talking about what the nurse plans to do after work.

ANS: A

Commitment involves performing at an optimal level to meet the patients needs. Delivering nursing care skillfully is the only appropriate behavior listed.

DIF: Cognitive Level: Application REF: p. 156 OBJ: 9

TOP: Commitment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

5. To communicate interest and caring to a patient of the majority culture, the nurse should

a.

call the patient on days off.

b.

keep conversation on a social level.

c.

direct the patient to make a list of all problems.

d.

make eye contact and encourage the patient to communicate.

ANS: D

Making eye contact is a means of conveying interest to patients of the majority culture. Encouraging and supporting communication is also a means of conveying interest. Calling the patient on days off is unnecessary. Keeping conversation on a social level is not therapeutic. Directing the patient to make a list of all problems might not be necessary or appropriate.

DIF: Cognitive Level: Application REF: p. 152 OBJ: 3

TOP: Communicating interest and caring

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6. A patient states, Im really turned off when the doctor hurries out of here. The nurse responds, Youre feeling upset with your doctor because he doesnt spend enough time with you. This interaction demonstrates

a.

summarizing.

b.

validating.

c.

clarifying.

d.

reflecting.

ANS: D

Reflecting involves putting into words the information received from the patient at an affective communication level. The example given does not relate to definitions of the other communication strategies.

DIF: Cognitive Level: Comprehension REF: p. 152 OBJ: 3

TOP: Reflecting KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7. The patient states, My pain is awful! The response that illustrates the use of focusing is:

a.

On a scale of 1 to 10, tell me the number that represents your level of pain.

b.

I am not sure I understand what youre telling me.

c.

You seem to be in considerable pain.

d.

Can you handle the pain youre having?

ANS: A

Focusing, or asking focused questions, prompts the patient to provide more definitive information. Asking a patient to rate his or her pain on a scale of 1 to 10 exemplifies this definition.

DIF: Cognitive Level: Application REF: p. 152 OBJ: 3

TOP: Focused questions

KEY: Nursing Process Step: Assessment (Data Collection)

MSC: NCLEX: Physiological Integrity

8. A patient states, This is my fourth miscarriage. A response by the nurse that demonstrates active listening would be

a.

Having another miscarriage must be hard to accept.

b.

This is natures way. You can be glad it happened.

c.

How lucky to have lost the baby so early in your pregnancy.

d.

Ive had two miscarriages, so I know how you must feel.

ANS: A

Reflection is a strategy that is useful in active listening. The statement, Having another miscarriage must be hard to accept is an example of reflection, or putting into words the affective communication received from the patient. The statements, This is natures way. You can be glad it happened and How lucky to have lost the baby so early in your pregnancy are insensitive and do not suggest active listening. The statement, Ive had two miscarriages, so I know how you must feel is nurse centered, and therefore not an example of active listening.

DIF: Cognitive Level: Application REF: p. 151 OBJ: 3

TOP: Active listening KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. The patient asks, What is an IVAC thermometer? The nurse replies, It is a heat-sensitive probe inserted into the sublingual area or rectal orifice. Heat transmission proceeds via an electrical system to a control center that interprets the temperature and displays it. This reply can be analyzed as

a.

one-way communication.

b.

active listening.

c.

unnecessary use of jargon.

d.

displaying sensitivity.

ANS: C

This explanation is unnecessarily scientific and uses nursing jargon when a simple answer would suffice. The communication described is two-way. Active listening involves responding therapeutically rather than in a confusing manner. The nurses response displays insensitivity.

DIF: Cognitive Level: Analysis REF: p. 154 OBJ: 4

TOP: Communication block KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. A patient states, I dont seem to be getting my strength back. The nurse replies, Dont worry. You are coming along just fine. This response is an example of

a.

probing.

b.

false reassurance.

c.

disagreeing.

d.

active listening.

ANS: B

False reassurance involves telling the patient that there is nothing to worry about when that may or may not be true. Probing means pushing for more information. Disagreeing conveys disapproval of the patients verbalization. Active listening is a therapeutic strategy.

DIF: Cognitive Level: Application REF: pp. 150-153 OBJ: 4

TOP: Communication block KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

11. A nurse tells a patient, There you are with varicose veins, sitting with your legs crossed at the knee. How often have we told you not to do that? This communication demonstrates

a.

giving advice.

b.

probing.

c.

chiding.

d.

requesting information.

ANS: C

Chiding is scolding. The intent of the communication is not to give advice but to chastise the patient for noncompliance. Probing is pushing for additional information. The question at the end of the scolding is rhetorical and does not ask for actual information.

DIF: Cognitive Level: Application REF: p. 153 OBJ: 4

TOP: Communication block KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. The nurse enters a patients room and asks, How are things today? The nurse has used

a.

an open-ended question.

b.

a focused question.

c.

probing.

d.

paraphrasing.

ANS: A

An open-ended question permits the patient to answer in whatever way is most meaningful. It is sometimes called a broad opening. The remaining options are incorrect, because focused questions permit only specific and narrow answers; probing suggests that the nurse is probing or digging for information; and paraphrasing allows the nurse to say in his or her own words the message conveyed by the patient.

DIF: Cognitive Level: Application REF: p. 152 OBJ: 3

TOP: Therapeutic communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

13. Characteristics of one-way communication include all of the following except

a.

it is sender controlled.

b.

receiver feedback is not expected.

c.

it always has negative value.

d.

it is useful to give commands.

ANS: C

Always having negative value is not a characteristic of one-way communication, because one-way communication may have either positive or negative value. The remaining options are characteristics of one-way communication.

DIF: Cognitive Level: Analysis REF: p. 150 OBJ: 1

TOP: One-way communication KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

14. Two-way communication differs from one-way communication, because with one-way communication

a.

the impact is positive.

b.

the receiver contributes as much as the sender.

c.

no feedback is expected.

d.

body language does not affect the receiver.

ANS: C

It is true that in one-way communication, the sender does not expect the receiver to provide feedback. The impact of one-way communication is not always positive. The receiver of one-way communication does not contribute to the interaction. Body language may affect the receiver.

DIF: Cognitive Level: Analysis REF: pp. 150-153 OBJ: 1

TOP: Comparison of one-way vs. two-way communication KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

15. A patient asks a practical/vocational nursing student the following questions. To which option should the nurse respond, I dont know the answer to your question, but Ill find someone who will discuss it with you?

a.

What do you mean when you say vital signs?

b.

May I get out of bed?

c.

How do I call a nurse when I need one?

d.

How much longer do I have to live?

ANS: D

Questions about prognosis and impending death are the responsibility of the physician or, in some cases, the advanced practice nurse. The LPN/LVN should know in advance what can be discussed with the patient and be prepared to refer the person to a more knowledgeable practitioner. The other options are examples in which the LPN/LVN is capable of giving answers.

DIF: Cognitive Level: Analysis REF: p. 150 OBJ: 3

TOP: Therapeutic communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

16. A patient who has had knee surgery tells the nursing student that he is doing fine and doesnt need anything. The student observes that he winces when moving in bed and that he has a worried frown. The student asks him to rate his pain on a numerical scale and then encourages him to take his prn analgesic. Which is true of this interaction?

a.

The nursing student recognized that the patients verbal and nonverbal messages were incongruent.

b.

The nursing student understood that verbal messages outrank nonverbal messages in importance.

c.

The nursing student realized that affective communication is of lesser importance.

d.

The nursing student used one-way communication effectively.

ANS: A

This is an example of incongruence between verbal and nonverbal communication, requiring further investigation. Verbal messages do not outrank nonverbal messages in importance, and affective communication is not of lesser importance. Two-way communication is being used in the scenario, not one-way communication.

DIF: Cognitive Level: Analysis REF: pp. 150-151 OBJ: 2

TOP: Incongruent verbal and nonverbal communication

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

17. Which option provides information that allows an individual to identify the patients affective state?

a.

Mr. B states that he is in considerable pain, about 8 on a scale of 1 to 10. He characterizes the pain as stabbing.

b.

Mrs. Ts facial expression looks sad. Tears well up in her eyes, and the corners of her mouth droop.

c.

Miss L lies still with her eyes shut, her arms held rigidly at her side, and her fists clenched.

d.

Mr. A listens carefully to the directions for blood glucose monitoring and then asks several relevant questions.

ANS: B

Affective communication is assessed by observing mood and emotions. Option B provides information on the patients affective state. The patient verbalizing that he is in pain and describing it is an example of verbal behaviors. Body language, such as lying still with the eyes closed, the arms held rigidly at the side of the body, and the fists clenched better describes nonverbal communication than affective state. A patient listening to directions and then asking relevant questions describes verbal communication.

DIF: Cognitive Level: Application REF: p. 151 OBJ: 2

TOP: Affective communication

KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: N/A

18. Which statement is true regarding open-ended, closed-ended, and focused questions?

a.

Open-ended questions always achieve their purpose.

b.

Closed-ended and focused questions are used to get specific information.

c.

Closed-ended questions are used primarily with children and the elderly.

d.

Focused questions are more useful when communicating with men.

ANS: B

Closed-ended and focused questions require the patient to give an answer that is narrower in scope than the answers possible for open-ended questions. Open-ended questions do not necessarily always achieve their purpose. Closed-ended questions may be useful with persons of any age. Focused questions are equally useful for men and women.

DIF: Cognitive Level: Comprehension REF: p. 152 OBJ: 3

TOP: Types of questions

KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: N/A

19. On which statement about cultural differences could the nurse rely when implementing patient care?

a.

The loud voices of a group of African Americans signal anger.

b.

Native Americans relate best to nurses who make frequent direct eye contact.

c.

Mexican Americans of the same sex rarely touch one another.

d.

Asian American patients may use less eye contact than African American patients.

ANS: D

Averting the eyes is a sign of respect when an Asian American is talking to a person of perceived higher status. African American patients convey respect by making and maintaining eye contact. Loud voices are the norm among African Americans talking with family or friends. Native Americans consider making eye contact a sign of disrespect. Touch is common among Mexican American members of the same sex, and personal space is close.

DIF: Cognitive Level: Analysis REF: p. 154 OBJ: 6

TOP: Cultural differences KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

20. On which statement about life span communication differences can the nurse rely when implementing patient care?

a.

Children from birth to age 2 are most soothed by a high-pitched tone of voice.

b.

Preschool children tend to respond well to a reasoning approach.

c.

It is important to try to communicate with teens using their slang.

d.

Elderly people hear lower frequency sounds more easily than high-pitched sounds.

ANS: D

Elderly people lose the ability to hear high-frequency sounds but are often able to hear lower frequency sounds. Using a low voice register will be more helpful than pitching the voice in the higher registers. Children from birth to age 2 are soothed by low-pitched voices. Preschool children have immature reasoning skills. Use of slang with teenagers is ill-advised, because meanings change with great speed.

DIF: Cognitive Level: Analysis REF: p. 158 OBJ: 8

TOP: Life-span communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

21. A patient tells the nurse, I dont know what to expect in the hospital. Everybody speaks medical-talk. Nobody tells me if Im getting better or worse. Doctors march in and poke and prod me without asking my permission. And another thing, I cant stay here forever; I have to look after my elderly mother. From these data the nurse can correctly determine that the patient is

a.

experiencing a difficult transition to the patient role.

b.

unnecessarily sensitive to loss of independence.

c.

excessively fearful of unknown aspects of hospitalization.

d.

suffering from sensory overload.

ANS: A

The patient is voicing concerns typical of someone experiencing negative aspects of role transition. Nothing is familiar, the patient feels left out, lacks privacy, and has a major personal concern regarding the elderly mother. The patients reactions would be considered normal. The patient is not demonstrating excessive fear. The patients complaints are not consistent with sensory overload.

DIF: Cognitive Level: Analysis REF: p. 154 OBJ: 7

TOP: Role transition to patient

KEY: Nursing Process Step: Assessment (Data Collection)

MSC: NCLEX: Physiological Integrity

22. A patient states, I dont want to die from cancer. The nurse responds, I heard you say you dont want to die from cancer. The nurses response is an example of which active listening behavior?

a.

Silence

b.

Validation

c.

Summarizing

d.

Minimal encouraging

ANS: C

Summarizing means briefly stating the main data gathered. For example: Nurse: This is what I heard you say. Is that correct? Silence involves pauses used with skill. Validation provides the patient with an opportunity to correct information, if necessary, at the time of summary. Minimal encouraging involves using sounds, words, or short phrases to encourage the patient to continue.

DIF: Cognitive Level: Analysis REF: p. 152 OBJ: 3

TOP: Active listening KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

23. A patient states, My chest incision hurts. I cant walk because of the pain. The nurse responds, Youve been unable to walk because of incisional pain. The nurses response is an example of which active listening behavior?

a.

Restating

b.

Reflection

c.

Clarification

d.

Paraphrasing

ANS: A

Restating refers to repeating in a slightly different way what the patient has said. Reflection is putting into words information received from the patient at an affective communication level. Clarification is asking a closed-ended question in response to a patients statement to be sure its understood. Paraphrasing refers to expressing in ones own words what one thinks the patient means.

DIF: Cognitive Level: Analysis REF: p. 152 OBJ: 3

TOP: Active listening KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

MULTIPLE RESPONSE

1. The practical/vocational nursing student is assigned the task of helping a new mother and father learn to bathe their newborn. The instructor asks the student how the session went, and the student replies, The mother seemed to understand everything. She smiled and nodded at everything I told her. The father watched and didnt ask any questions. The instructor comments, Without validation, you cant be sure. Which statements contributed to the instructors knowledge on which to base the comment to the student? (Select all that apply.)

a.

Women nod to show that they are listening.

b.

Men ask fewer questions than women.

c.

Women smile to establish rapport.

d.

Nonverbal communication is a good indicator of understanding.

ANS: A, B, C

The facts that women nod to show they are listening, men ask fewer questions than women, and women smile to establish rapport serve as a basis for the instructor mentioning the need for validation of patient understanding. None of these actions prove that the new parents understood what the nursing student was teaching. Nonverbal communication is not a good indicator of understanding and may belie what is actually occurring.

DIF: Cognitive Level: Analysis REF: p. 153 OBJ: 5

TOP: Male/female differences KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2. Types of communication include which of the following? (Select all that apply.)

a.

Verbal communication

b.

Affective communication

c.

Nonverbal communication

d.

Symptomatic communication

ANS: A, B, C

The three types of communication are verbal communication (spoken or written word), nonverbal communication (body language), and affective communication (feeling, tone). Symptomatic communication does not exist.

DIF: Cognitive Level: Knowledge REF: pp. 150-151 OBJ: 2

TOP: Types of communication KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

3. A nurse does not make eye contact when talking with others. What are possible explanations for this behavior? (Select all that apply.)

a.

The nurse is self-conscious and nervous.

b.

The nurse has low self-worth.

c.

The nurses behavior is culturally determined.

d.

The hospital forbids eye contact.

ANS: A, B, C

All of the options are possible explanations for not making eye contact except the hospital forbidding eye contact.

DIF: Cognitive Level: Application REF: p. 151 OBJ: 2

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

MSC: NCLEX: N/A

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