Chapter 14: Communicating With Patients and Co-Workers My Nursing Test Banks

Chapter 14: Communicating With Patients and Co-Workers

Test Bank

MULTIPLE CHOICE

1. The instructor asks the nursing student to define therapeutic communication. The students most appropriate response is that therapeutic communication refers to:

a.

psychotherapy.

b.

social communication.

c.

developing a trusting relationship.

d.

emotional commitment to another.

ANS: C

The purpose of therapeutic communication is to establish a trusting relationship. The RN should try to understand with sensitivity. Therapeutic communication and the establishment of the therapeutic relationship require empathy, genuineness, positive regard, and self-awareness. Psychotherapy, social communication, and emotional commitment to another are not definitions of therapeutic communication.

DIF: Cognitive Level: Knowledge REF: Page 211

OBJ: Define therapeutic communication. TOP: The RN as Communicator

MSC: NCLEX: Psychosocial Integrity

2. An example of a communication blocker is:

a.

silence.

b.

eye contact.

c.

advising.

d.

clarifying.

ANS: C

Communication blockers tend to stop conversation and build mistrust. Giving advice fosters dependency and conveys to the patient that the nurse knows best. Silence, eye contact, and clarifying are techniques that enhance (facilitate) communication.

DIF: Cognitive Level: Knowledge REF: Pages 212-213

OBJ: State four techniques that can hinder communication. TOP: The RN as Communicator

MSC: NCLEX: Psychosocial Integrity

3. The nurse is caring for a patient 2 hours after a left above-the-knee amputation. The patient states, My left leg is really hurting, and that medicine you gave me earlier didnt help. Which response is the most therapeutic, if made by the nurse?

a.

Thats impossible!

b.

Youll have to talk to your doctor.

c.

Keep your chin up.

d.

I will call your physician.

ANS: D

I will call your physician is validating the patients perception of pain. Thats impossible! minimizes the patients feelings. Youll have to talk to your doctor may cause the patient to feel rejected by the nurse. Making a stereotypical comment such as Keep your chin up is never therapeutic.

DIF: Cognitive Level: Application REF: Page 212

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

4. The RN is documenting the patients complaint of pain rated 6 on a scale of 0 to 10. Which chart entry would be the most appropriate, if made by the nurse?

a.

Pt. complaining of pain. MD notified.

b.

Pt complaining of pain rated at 6 on a scale of 0-10, states My left leg is really hurting. Pt. grimacing, voice elevated. MD notified.

c.

Pt. complaining of pain rated at 6 on a scale of 0-10. Appears to be in pain. MD notified.

d.

Pt. complaining of pain rated 6. Wants more pain medication; appears to be drug-seeking. MD notified.

ANS: B

With Pt complaining of pain rated at 6 on a scale of 0-10, states My left leg is really hurting. Pt. grimacing, voice elevated. MD notified, the entry contains the problem, the assessment, subjective comments, observations, and the plan. The entry Pt. complaining of pain. MD notified, does not define the patients pain. The entries Pt. complaining of pain rated at 6 on a scale of 0-10. Appears to be in pain. MD notified and Pt. complaining of pain rated 6. Wants more pain medication; appears to be drug-seeking. MD notified reflect opinions of the nurse.

DIF: Cognitive Level: Application REF: Page 231

OBJ: Apply the principles of written documentation as a form of communication.

TOP: The RN as Communicator

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. The RN has assigned the nursing assistant (NA) a task. The NA becomes angry and begins yelling at the RN. What is the best approach for the RN to take?

a.

Tell the NA that you will let her leave early if she will do this for you.

b.

Ignore her and reassign the task.

c.

Meet with the NA to explore his or her feelings and the reason for resistance.

d.

Call the nursing supervisor and report the NA for insubordination.

ANS: C

Meeting with the NA to explore the reason for resisting the request is the best approach in order to address the underlying issue. Telling the NA that you will let her leave early if she will do this for you and ignoring her and reassigning the task are negative reinforcements and will likely perpetuate the behavior. Calling the nursing supervisor and reporting the NA for insubordination should occur if the RN has been unsuccessful in resolving the problem.

DIF: Cognitive Level: Application REF: Page 228

OBJ: Apply the principles of effective communication to the clinical setting.

TOP: The RN as Communicator

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

6. The nurse is caring for a 64-year-old woman 4 hours after knee replacement. Although she rates her pain at 6 out of 10, she refuses pain medication and tells the nurse, I can deal with it. Which of the following is the nurses best response?

a.

OK, thats your decision.

b.

Youre just being stubborn.

c.

OK, Ill come back later.

d.

What is your concern?

ANS: D

Encouraging the patient to talk about her concerns is the most therapeutic response in order to determine the reason for the refusal of pain medication. The comments, OK, thats your decision and Youre just being stubborn are judgments and not therapeutic statements. The comment OK, Ill come back later is not an appropriate response in this case because nothing is done to relieve the patients pain.

DIF: Cognitive Level: Application REF: Page 212

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

7. Which statement, if made by the nurse, is an example of a communication technique that can facilitate communication?

a.

Yes, I agree with you.

b.

You need to talk to your doctor.

c.

I know just how you feel.

d.

What are you thinking about?

ANS: D

Using open-ended questions such as What are you thinking about? are more likely to facilitate communication. Making comments such as Yes, I agree with you and You need to talk to your doctor are not therapeutic communication techniques. Stating I know just how you feel is never therapeutic because no one can say how another person feels even if the nurse had a similar experience.

DIF: Cognitive Level: Application REF: Page 212

OBJ: Apply the principles of effective communication to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

8. The nurse is working in the outpatient clinic when a patient who has been waiting to be seen for an hour yells, What are you people doing? Im sick and tired of waiting! Which response is the most therapeutic, if made by the nurse?

a.

The doctor can only do so much.

b.

Would you like a magazine?

c.

I can see that you are frustrated.

d.

You need to be quiet!

ANS: C

Acknowledging the patients frustration with I can see that you are frustrated indicates that the nurse is listening and that the message has been received. Stating The doctor can only do so much is defensive and minimizes the patients issue. Asking Would you like a magazine? is a change of subject that discounts the patients feelings and is likely to irritate the patient further. Stating You need to be quiet! shows a total disregard for the patients frustration.

DIF: Cognitive Level: Application REF: Page 212

OBJ: Apply the principles of therapeutic communication to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

9. The physician orders a dose of morphine that the nurse considers excessive. The nurse should:

a.

administer the medication.

b.

ask another nurse to administer the medication.

c.

call the supervisor.

d.

contact the physician.

ANS: D

The physician must be notified for clarification of the dose. If the nurse still considers the dose excessive, he or she may refuse to administer it. Administering the medication is not a safe option, nor is asking another nurse to administer it. If the issue cannot be resolved between the nurse and physician, the supervisor should be notified.

DIF: Cognitive Level: Application REF: Page 230

OBJ: Apply the principles of effective communication to the clinical setting.

TOP: The RN as Communicator

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

10. The nurse is caring for a patient following painful radiation treatment for newly diagnosed cancer. Which question, if asked by the nurse in the orientation phase of the nurse-patient relationship, is most likely to elicit a meaningful response?

a.

Dont you love this weather?

b.

How have things been going for you?

c.

Tell me why you didnt stop smoking.

d.

Are you having any pain?

ANS: D

Pain must first be addressed before the interview can proceed. Dont you love this weather? is a general and nondescript comment. How have things been going for you? is best offered once pain has been assessed and treated. Exploration of needs, feelings, emotions, and concerns would be addressed in the working phase. Tell me why you didnt stop smoking is likely to elicit a defensive response and will hinder therapeutic communication.

DIF: Cognitive Level: Application REF: Pages 214-215

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

11. During the therapeutic relationship with a patient, which of the following is the primary focus of care?

a.

Meeting the needs of the nurse

b.

Medication administration

c.

The patients needs and problems

d.

Self-care potential

ANS: C

The primary focus of care is on the patients needs and problems. The focus of the nurse-patient therapeutic relationship is never to meet the needs of the nurse. Medication administration and self-care potential can be addressed once needs and problems have been identified.

DIF: Cognitive Level: Knowledge REF: Page 211

OBJ: State the purpose of the therapeutic relationship. TOP: The RN as Communicator

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. A patient scheduled for surgery has a severe level of anxiety. Which action, if taken by the nurse, would be most appropriate at this time?

a.

Providing teaching about the upcoming surgery and what to expect

b.

Telling the patient that there is nothing to worry about

c.

Calling the patients family and demanding that they help out

d.

Asking the patient about her concerns, feelings, and perceptions about the surgery

ANS: D

The most appropriate action for the nurse to take at this time is to ask the patient about her concerns, feelings, and perceptions about the surgery. Providing teaching during periods of high anxiety is ineffective and does not address the patients anxiety. Telling the patient that there is nothing to worry about is giving false reassurance. Calling the patients family and demanding that they help out is projecting the nurses frustration onto the family and avoiding responsibility.

DIF: Cognitive Level: Application REF: Page 212

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

13. Which of the following would be most appropriate to assess first for the newly admitted Chinese patient?

a.

Pain

b.

Language barrier

c.

Family support

d.

Religious preference

ANS: B

The nurse must first assess the ability to communicate with the patient before pain, family support, or religious preference can be assessed.

DIF: Cognitive Level: Knowledge REF: Pages 214-215

OBJ: State three factors that can negatively affect therapeutic communication.

TOP: The RN as Communicator

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

14. The nurse and patient are discussing the patients perceptions and feelings related to the patients illness. The patient is emotional and tearful and expresses feelings of hopelessness. During which phase of the nurse-patient relationship does this typically occur?

a.

Preorientation

b.

Orientation

c.

Working

d.

Termination

ANS: C

Discussing perceptions and feelings typically occurs in the working phase, at which time intense emotions may arise. Preorientation is not a phase of the nurse-patient relationship. The orientation phase includes introductions and goal setting. The termination phase is the completion of the nurse-patient relationship as a result of discharge, transfer, or the nurses time off.

DIF: Cognitive Level: Knowledge REF: Page 215

OBJ: Describe the four phases of the nurse-patient relationship and nursing actions related to each.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

15. A nurse has a plan for teaching the patient about a newly diagnosed disease. On entering the room the nurse realizes that the patient is blind. What considerations for communication should the nurse be aware of?

a.

Tone, pitch, inflection, and intensity affect how messages are communicated.

b.

Messages are clearer when verbal communication and nonverbal cues are opposite.

c.

Verbal communication must be understood within the context of a patients culture, gender, and age.

d.

Facial expressions and eye contact are characteristics of verbal communication.

ANS: A

Communication is the interaction between two or more individuals in which an exchange of information occurs. How we communicate is as important as what we communicate. For instance, tone, pitch, inflection, and intensity of how we speak affect how messages are communicated. Tone, pitch, inflection, and intensity are examples of nonverbal communication and affect how messages are communicated. Messages are clearer when verbal communication and nonverbal cues are agreeable. Nonverbal communication must be understood within the context of a patients culture, gender, and age. Facial expressions, personal appearance, eye contact, eye cast, and physical characteristics are examples of nonverbal communication.

DIF: Cognitive Level: Application REF: Page 210

OBJ: Apply the principles of effective communication to the clinical setting.

TOP: The RN as Communicator

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

16. The nursing student addresses an 86-year-old patient by his first name at their initial meeting. To the patient, this behavior:

a.

is a sign of the nursing students empathy for the patient.

b.

could be interpreted as a lack of respect on the part of the student.

c.

clearly indicates that the student feels comfortable working with the patient.

d.

indicates that the student is establishing firm boundaries for the relationship.

ANS: B

Addressing an older adult by his first name by the nursing student may be interpreted as a lack of respect. Regarding therapeutic communication, positive regard implies respect and a willingness to work with the patient and communicate (through your actions) that the patient is a person worthy of caring about. Empathy is the ability to perceive the patients needs, feelings, and situation accurately. Focus on the student nurse is incorrectly directed with the answer choices that discuss the student nurses feeling comfortable working with the patient and the student nurses establishing boundaries for the nurse-patient relationship.

DIF: Cognitive Level: Application REF: Page 211

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

17. When considering the creation of an environment for emotional support in a therapeutic relationship, the primary focus of the nurse should be:

a.

removing stressors that cause anxiety and fear.

b.

developing a trusting relationship.

c.

encouraging the patient to become independent.

d.

allowing the patient to be in control of medical decision-making.

ANS: B

Establishing trust is a primary activity of the therapeutic relationship. The nurse must project warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family. Removing stressors, encouraging independence, and allowing the patient to be in control of medical decision-making are not therapeutic communication facilitators.

DIF: Cognitive Level: Application REF: Page 212

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

18. A patient has just been informed by the physician that he will not be discharged today. The nurse brings in the patients lunch tray and puts it on the overbed tray. The patient pushes it off onto the floor and shouts, Get out of my room and leave me alone. The nurses most therapeutic response would be:

a.

Is there something wrong with your lunch tray?

b.

You seem angry. Can you tell me about it?

c.

Why are you angry? You seemed so much happier earlier today.

d.

Ill order you another lunch, and Ill be back when youre in a better mood.

ANS: B

You seem angry. Can you tell me about it? is the most therapeutic response. The nurse must project warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family. Additionally, empathy is the ability to perceive the patients needs, feelings, and situation accurately. Additionally, asking open-ended questions allows the patient to express thoughts and feelings freely with no response limitations. The other answer items are not examples of a therapeutic response to the angry patient.

DIF: Cognitive Level: Application REF: Page 212

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

19. When preparing for patient teaching what should the nurse do first?

a.

Assess the learners needs.

b.

List key points to be presented.

c.

Collect the teaching materials.

d.

Think about how the skill can be done at home.

ANS: A

The principles of teaching and learning should be applied to make an accurate assessment of learning needs and evaluate the effectiveness of the teaching provided. Listing key points, collecting teaching materials, and thinking about how a skill can be done at home are all considerations after learning needs are assessed.

DIF: Cognitive Level: Application REF: Page 220

OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: Health Literacy

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

20. Laura, a nurse manager, is meeting with the staff, which consists of nurses from the Veteran, Baby Boomer, Generation X, and Millennial generations. Which of the following is the best approach to encouraging collaboration and feedback from everyone?

a.

Ask for volunteers to form a committee to explore the issue.

b.

Form a committee made up of at least one representative from each generation.

c.

Form a committee primarily composed of experienced, older nurses.

d.

Meet with each nurse individually to solicit feedback.

ANS: B

Forming a committee made up of representatives from each generation is more likely to result in more collaborative and meaningful discussions. Asking for volunteers to form a committee would likely result in one generation being primarily represented and does not encourage collaboration among the generations. Forming a committee of experienced, older nurses, discriminates against other generations and experience. Meeting with each nurse does not encourage collaboration because it does not allow staff members to interact.

DIF: Cognitive Level: Analysis REF: Pages 222-224

OBJ: Compare and contrast generational differences in the workplace.

TOP: Professional Roles

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. Before signing the verbal orders given earlier, the physician notifies the nurse of incorrectly wording the order. The physician requests the nurse to go back and insert the missing information. Which actions illustrate a lack of knowledge by the nurse? (Select all that apply.)

a.

Use a black pen and insert the missing information.

b.

Insist that the physician write a new order.

c.

Write an addendum clarifying the order.

d.

Toss the old order and write a new one.

ANS: A, B, D

The nurse should not add information to an order once it has been signed. It is not necessary for the physician or nurse to write a new order, and this may alienate the physician. No order should ever be thrown away because it is a permanent part of the patients medical record. The nurse should write an addendum clarifying the original order.

DIF: Cognitive Level: Application REF: Page 231

OBJ: Apply the principles of written documentation as a form of communication in the clinical setting. TOP: The RN as Communicator

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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