Chapter 26 My Nursing Test Banks

Kozier & Erbs Fundamentals of Nursing, 10/E
Chapter 26

Question 1

Type: MCSA

A nurse explains to a client that he will need to have a bowel prep before going to his esophagogastroscopy. On what should the nurse focus to improve communication skills?

1. Pace

2. Intonation

3. Simplicity

4. Clarity

Correct Answer: 3

Rationale 1: Pace helps indicate interest, anxiety, boredom, or fearall of which modify the feeling and impact of the message.

Rationale 2: Intonation helps indicate interest, anxiety, boredom, or fearall of which modify the feeling and impact of the message.

Rationale 3: Simplicity includes the use of commonly understood words, brevity, and completeness. A bowel prep may be completely meaningless to a client, but telling him that he needs to drink a gallon of laxative-like medication gets the point across better. Esophagogastroscopy is a complicated word. Using words like small camera looking down your throat into your stomach will make much more sense to the client.

Rationale 4: Clarity and brevity imply that the message is direct and simplesaying precisely what is meant and using the fewest words necessary.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Discuss the various aspects that nurses need to consider when using the different forms of communication.

MNL Learning Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 413

Question 2

Type: MCSA

The nurse observes during a dressing change that the clients wound has become infected. When asked by the client how the wound looks, the nurse says it looks fine but the nurses facial expression doesnt support the response. Which aspect of communication should this nurse improve?

1. Adaptability

2. Credibility

3. Timing and relevance

4. Clarity and brevity

Correct Answer: 1

Rationale 1: Adaptability is adjusting tone of speech and facial expression to match the spoken message. Clearly, if the nurses face doesnt match his words, the client will identify a problem with the situation.

Rationale 2: Credibility means worthiness of belief, trustworthiness, and reliability.

Rationale 3: Timing and relevance affect how the message is taken or heard.

Rationale 4: Clarity and is preciseness and brevity is use of few words.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Describe the components of the communication process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 413

Question 3

Type: MCSA

A nurse is working on a telemetry unit when one of the clients has a cardiac arrest. The clients spouse is in the room when the code team arrives. Which statement by the nurse to the spouse is the best in this situation?

1. I know youre worried about your loved one. Im sure this is a difficult situation for you. Do you have any questions right now?

2. Your spouses heart stopped. All these people are here to help get it started.

3. Your spouses physician will be here shortly and explain all of the medication and treatment that your spouse is receiving right now.

4. Is there someone you would like to call? Im sure this is a scary situation and you may feel more comfortable if someone were with you during this time.

Correct Answer: 2

Rationale 1: Dealing with the spouses fears and concerns right now is not the priority needthe clients emergency situation is.

Rationale 2: Clarity and brevity provide a message that is simple and clear.

Rationale 3: In this situation, taking time to explain and/or address all of the spouses needs and concerns is inappropriate. Not only will the client be unable to process extra information, but the nurse doesnt have time to give long, drawnout explanations about the situation.

Rationale 4: In this situation, taking time to explain and/or address all of the spouses needs and concerns is inappropriate. Not only will the client be unable to process extra information, but the nurse doesnt have time to give long, drawnout explanations about the situation.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Discuss the various aspects that nurses need to consider when using the different forms of communication.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 413

Question 4

Type: MCSA

The nurse enters a clients room and finds that the telephone is lying in the clients lap, tissues are wadded up on the bed, and the clients eyes are red and watery. What is the best response by the nurse?

1. Can I hang that phone up for you?

2. Well, its a beautiful day outside. Lets open the blinds.

3. Has your doctor been in to talk to you yet?

4. You look upset. Is there anything youd like to talk about?

Correct Answer: 4

Rationale 1: This option does not address the nonverbal cues. The phone off the hook should lead the nurse to at least consider that perhaps the client had an upsetting phone call. This should be addressed by the nurse.

Rationale 2: This option does not address the nonverbal cues.

Rationale 3: This option does not address the nonverbal cues.

Rationale 4: Nonverbal communication, or body language, often tells the nurse more about what a person is feeling than what is actually said. The interpretation of such observations requires validation with the client.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe factors influencing the communication process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 414

Question 5

Type: MCSA

A client has been sullen and withdrawn since receiving the news of her cancer diagnosis. As the nurse enters the room, the client asks for assistance with a shower. Which comment by the nurse is the most appropriate?

1. If you look better, you might feel better.

2. Taking a shower might wash away some of that gloom and doom.

3. This is a positive sign. Ill be right back with your supplies.

4. Your spouse will be glad to see that youre feeling better.

Correct Answer: 3

Rationale 1: Telling the client that she might feel better if she looks better implies that the clients looks are objectionable.

Rationale 2: Suggesting that washing away the gloom and doom minimizes the clients concerns.

Rationale 3: How a person dresses or looks may be an indicator of how the person feels. A change in grooming habits may signal that the client is feeling better.

Rationale 4: A change in grooming habits may signal that the client is feeling better, but the nurse must be careful in this situation that the focus is not on the clients spouse, but on the client.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe factors influencing the communication process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 415

Question 6

Type: MCSA

A nurse is working in a pediatric clinic and has to explain a nebulizer treatment to a child. Which approach should the nurse use?

1. Give the childs parent a full explanation, but make sure the child hears what is said.

2. Let the child handle the equipment first, then demonstrate on the childs doll.

3. Start the treatment, but make sure that the parent is there to comfort the child if she becomes afraid.

4. Make sure that the physician is available for questions.

Correct Answer: 2

Rationale 1: The nurse should not talk over or around the child, just because of her age, but include her in conversation and communication.

Rationale 2: The knowledge of the clients developmental stage will allow the nurse to modify the message accordingly. The use of dolls and games with simple language may help explain a procedure to a child.

Rationale 3: Before any treatment or therapy, explanation should be given. Otherwise the child will be frightened and the treatment will not be effective.

Rationale 4: Nurses should always be prepared to give explanations and teaching to their clients.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe factors influencing the communication process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 416

Question 7

Type: MCSA

A nurse is giving a demonstration of new equipment to the rest of the nursing unit. Which level of proxemics should the nurse use?

1. Intimate

2. Personal

3. Social

4. Public

Correct Answer: 3

Rationale 1: Intimate distance is touching or up to 11/2 feet. This would be appropriate when cuddling a baby, touching a sightless client, repositioning a client, observing an incision, and restraining a toddler for an injection.

Rationale 2: Personal distance is 11/2 to 4 feet and is less overwhelming than intimate distance. Much communication between nurses and clients occurs at this distance, such as sitting with a client, giving medications, or establishing an IV.

Rationale 3: Social distance is characterized by a clear, visual perception of the whole person and generally 4 to 12 feet in distance. Social distance is important in accomplishing the business of the day. It is expedient in communicating with several people at the same time or within a short time, which would be the case in this situation.

Rationale 4: Public distance is 12 to 15 feet and requires loud, clear vocalizations. It is used most often with a group of people or in the community.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe factors influencing the communication process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 416

Question 8

Type: MCSA

A nurse must perform a catheterization on a male client. Which zone of proximity should the nurse use for this intervention?

1. Personal distance

2. Intimate distance

3. Social distance

4. Public distance

Correct Answer: 2

Rationale 1: Personal distance is 11/2 to 4 feet and is less overwhelming than intimate distance. Much communication between nurses and clients occurs at this distance, such as sitting with a client, giving medications, or establishing an IV infusion.

Rationale 2: Intimate distance is characterized by body contact and used frequently by nurses when they are required to perform a

procedure. Distance in this category is touching to 11/2 feet.

Rationale 3: Social distance is characterized by clear visual perception of the whole person and is important in accomplishing the business of the day.

Rationale 4: Public distance requires loud, clear vocalizations and is used for groups of people or in the community for presentations.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 13. Assess own level of communication skill in encounters with patients and families

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe factors influencing the communication process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 416

Question 9

Type: MCSA

A nurse enters a clients room and asks about his level of pain. The client, grimacing, says Its fine. Which communication factor is the client struggling with?

1. Territoriality

2. Environment

3. Congruence

4. Attitude

Correct Answer: 3

Rationale 1: Territoriality is a concept of the space and things that an individual considers as belonging to the self.

Rationale 2: The environment involved in communication must be comfortable. Otherwise it may distract and impair communication.

Rationale 3: In congruent communication, the verbal and nonverbal aspects of the message match. Saying his pain level is fine, but then showing with facial grimacing that it is not, would be in conflict.

Rationale 4: Attitudes can convey beliefs, thoughts, and feelings about people and eventsnot what is described in this scenario.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe factors influencing the communication process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 418

Question 10

Type: MCSA

A nurse is working with an elderly male client on a medical unit. Which statement demonstrates elderspeak by the nurse?

1. Its time for us to go to physical therapy.

2. I think it would be better if you were planning to go to a nursing home after discharge.

3. Your children must really love their dad.

4. Your wife must be having trouble adjusting to your illness.

Correct Answer: 1

Rationale 1: Elderspeak is a speech style, similar to baby, talk that gives a message of dependence and incompetence to older adults. Characteristics of elderspeak include inappropriate terms of endearment, inappropriate plural pronoun use (its time for us to go to

physical therapy), tag questions, and slow, loud speech.

Rationale 2: Telling the client that he needs to go to a nursing home is insensitive.

Rationale 3: Noting that the children love their father is not an example of elderspeak, but merely the nurse making observations to the client.

Rationale 4: Making comments about the wifes adjustments to the illness is not an example of elderspeak, but merely the nurse making observations to the client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Compare and contrast therapeutic communication techniques that facilitate communication and focus on client concerns.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 418

Question 11

Type: MCSA

A client has just lost her second baby to preterm complications. Which statement demonstrates the best therapeutic response for the nurse to make?

1. Dont be so sad. You can always try again.

2. Didnt your doctor advise you about genetic counseling?

3. I know how you feel. I have children of my own.

4. I am so sad for you. Ill stay with you for a while if you need to talk.

Correct Answer: 4

Rationale 1: The clients feelings must be validated, not dismissed.

Rationale 2: Asking about genetic counseling implies that the client could have done something to possibly prevent this situation.

Rationale 3: Therapeutic communication promotes understanding and is client directed. Nurses need to respond to the feelings expressed by the client. The nurse has no way of knowing how this client feels, and saying so is just insensitive.

Rationale 4: Therapeutic communication promotes understanding and is client directed. Nurses need to respond to the feelings expressed by the client. Sometimes clients need time to deal with their feelings and the best thing the nurse can provide is presence and listening.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare and contrast therapeutic communication techniques that facilitate communication and focus on client concerns.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 419

Question 12

Type: MCSA

The nurse is conducting an admission interview. Which response indicates that the nurse is attentively listening to the clients explanations?

1. Can you explain what your symptoms are like?

2. When was the last time you saw a doctor for this?

3. Uh-huh, while nodding the head

4. Im sorry, say that again?

Correct Answer: 3

Rationale 1: This is an example of clarifying.

Rationale 2: This is an example of clarifying.

Rationale 3: A nurse can convey attentiveness in listening to clients in various ways. Common responses are nodding the head, uttering uh-huh or mmm, repeating the words the client has used, or saying I see what you mean.

Rationale 4: This is an example of clarifying.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9. Discuss how nurses use communication skills in each phase of the nursing process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 419

Question 13

Type: MCMA

The nurse is engaging a client in the introductory phase of the helping relationship. Which stages will be completed during this phase?

Standard Text: Select all that apply.

1. Opening the relationship

2. Clarifying the problem

3. Structuring and formulating the contract

4. Planning before the interview

5. Understanding thoughts and feelings

Correct Answer: 1, 2, 3

Rationale 1: The introductory phase, also referred to as the orientation phase or prehelping phase, sets the tone for the rest of the relationship. The relationship opens during this phase.

Rationale 2: The introductory phase, also referred to as the orientation phase or prehelping phase, sets the tone for the rest of the relationship. Clarifying the problem occurs during this phase.

Rationale 3: The introductory phase, also referred to as the orientation phase or prehelping phase, sets the tone for the rest of the relationship. Structuring and formulating the contract occurs during this phase.

Rationale 4: Planning before the interview is part of the preinteraction phase.

Rationale 5: Understanding thoughts and feelings occurs during the working phase of the helping relationship.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Describe the four phases of the helping relationship.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 423

Question 14

Type: MCSA

During an interaction between a nurse and client, the nurse conveys respect and an attitude that shows the nurse takes the clients opinions seriously. In which stage of the working relationship are the nurse and client engaged?

1. Exploring and understanding thoughts and feelings

2. Facilitating and taking action

3. Confrontation

4. Concreteness

Correct Answer: 1

Rationale 1: The working phase has two major stages. Exploring and understanding thoughts and feelings would occur during the working relationship.

Rationale 2: Conveying respect and an attitude that demonstrates the clients opinions are being taken seriously would not be completed during the facilitating and taking action phase.

Rationale 3: Confrontation is a skill required for the first phase.

Rationale 4: Concreteness is a skill required for the first phase.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6. Describe the four phases of the helping relationship.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 423

Question 15

Type: MCSA

Several nurses have been assigned to develop a rotation schedule that provides adequate staffing of all shifts. In which type of group are these nurses functioning?

1. Self-help group

2. Task group

3. Teaching group

4. Therapy group

Correct Answer: 2

Rationale 1: A self-help group is a small, voluntary organization composed of individuals who share a similar health, social, or daily living problem.

Rationale 2: The task group is one of the most common types of work-related groups to which nurses belong. The focus of such groups is the completion of a specific task.

Rationale 3: A teaching group has as its major purpose to impart information to the participants.

Rationale 4: A therapy group works toward self-understanding, more satisfactory ways of relating or handling stress, and changing patterns of behavior toward health.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8. Identify types of groups helpful in promoting health and comfort.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 426

Question 16

Type: MCSA

The nurse is identifying communication strategies for a client unable to speak. What would be appropriate for the client in this situation?

1. Using a picture board to facilitate communication

2. Facing the client when speaking

3. Employing an interpreter

4. Making sure that the language spoken is the clients dominant language

Correct Answer: 1

Rationale 1: The picture board would be of assistance because it does not rely on verbal communication.

Rationale 2: The client is nonverbal, so speaking en face does not address the clients ability to communicate.

Rationale 3: The client is nonverbal, so using an interpreter does not address the clients ability to communicate.

Rationale 4: The client is nonverbal, so using the clients dominant language does not address the clients ability to communicate.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare and contrast therapeutic communication techniques that facilitate communication and focus on client concerns.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 429

Question 17

Type: MCSA

A nurse needs to evaluate the effectiveness of a teaching session with a client. Which approach would provide the best feedback?

1. Client communication

2. Process recording

3. Therapeutic communication

4. Verbal communication

Correct Answer: 2

Rationale 1: Client communication is a type of communication that does not provide a vehicle for evaluation.

Rationale 2: A process recording is a word-for-word account of a conversation. It includes all verbal and nonverbal interactions of both the client and nurse. It would be appropriate to use for evaluating the effectiveness of a teaching session.

Rationale 3: Therapeutic communication does not provide a vehicle for evaluation.

Rationale 4: Verbal communication does not provide a vehicle for evaluation.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9. Discuss how nurses use communication skills in each phase of the nursing process.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 430

New Question 18

Question 18

Type: MCMA

During a health history, a client admits to taking nutritional supplements instead of prescribed medication. Which responses by the nurse indicate effective communication?

Standard Text: Select all that apply.

1. What you did was wrong.

2. Who do you think you are?

3. You shouldnt have done that.

4. Tell me more about the supplements.

5. Explain the reasoning behind your decision.

Correct Answer: 4, 5

Rationale 1: Saying that the client was wrong is passing judgment, a common communication barrier.

Rationale 2: Asking the client who do you think you are is testing, a common communication barrier.

Rationale 3: Saying that the client should not have done that is passing judgment, a common communication barrier.

Rationale 4: Asking the client to tell more about the supplements is an open-ended statement and encourages communication.

Rationale 5: Asking the client to explain the reasoning behind the decision is an open-ended statement and encourages communication.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5. Recognize barriers to communication.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 420

Question 19

Type: MCSA

The nurse needs to communicate information about a clients status to a physician. Which approach demonstrates assertive communication by the nurse?

1. You need to check the laboratory results of the client in room 423.

2. You should visit with the clients family about the upcoming procedure.

3. We need to be more aware of the situation among the client and the clients family.

4. I am concerned that the client does not have adequate pain management.

Correct Answer: 4

Rationale 1: An important characteristic of assertive communication includes the use of I statements versus you statements. You statements place blame and put the listener in a defensive position.

Rationale 2: An important characteristic of assertive communication includes the use of I statements versus you statements. You statements place blame and put the listener in a defensive position.

Rationale 3: An important characteristic of assertive communication includes the use of I statements versus you statements. We statements are not a part of assertive communication.

Rationale 4: An important characteristic of assertive communication includes the use of I statements versus you statements. I statements encourage discussion.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 12. Discuss the differences between nurse and physician communication and how to address these differences.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 434

Question 20

Type: MCSA

The nurse wants to gain information about a clients situation. Which question should the nurse use to maximize communication with this patient?

1. What brings you to the hospital?

2. Are you having pain?

3. Does your pain feel better or worse today?

4. Is there anything I can do for you?

Correct Answer: 1

Rationale 1: An open-ended question is one that cannot be answered with a simple yes/no or a one-word response. Often they begin with the words What, Describe for me, Explain, or Tell me about.

Rationale 2: This question can be answered with one word or a yes/no response.

Rationale 3: This question can be answered with one word or a yes/no response.

Rationale 4: This question can be answered with one word or a yes/no response.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Compare and contrast therapeutic communication techniques that facilitate communication and focus on client concerns.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 420

Question 21

Type: MCMA

The nurse is communicating with an older client. Which actions demonstrate that the nurse understands the best approaches to communicate with this client?

Standard Text: Select all that apply.

1. Asking, What can I do to make you feel safe?

2. Observed intently listening to the client describe how being alone makes her feel

3. Offering to take the client out for a walk

4. Consistently arranging for the client to have her hair done

5. Managing to get a copy of the clients favorite magazine

Correct Answer: 1, 2, 5

Rationale 1: Good communication with the client will result in knowing what makes a difference to her. With this valuable knowledge, the nurse can reduce vulnerability and enhance the quality of life.

Rationale 2: Good communication with the client will result in knowing what makes a difference to her. With this valuable knowledge, the nurse can reduce vulnerability and enhance the quality of life.

Rationale 3: This would be effective only if the nurse knew that going for a walk was important to the client.

Rationale 4: This would be effective only if the nurse knew that getting her hair done was important to the client.

Rationale 5: Good communication with the client will result in knowing what makes a difference to her. With this valuable knowledge, the nurse can reduce vulnerability and enhance the quality of life.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10. State why effective communication is imperative among health professionals.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 423

Question 22

Type: MCMA

The nurse is beginning a helping relationship with a newly admitted client. Which behaviors should the nurse demonstrate that support this type of relationship?

Standard Text: Select all that apply.

1. Becoming familiar with the clients social history by reading the admission interview

2. Orienting the client to the physical layout of the facility as well as to the facilitys policies

3. Gaining the clients trust by consistently keeping promises to return and visit

4. Respecting the clients wish to be alone after hearing about the loss of a family friend

5. Asking to remain with the client when he is experiencing symptoms of the flu

Correct Answer: 1, 3, 4, 5

Rationale 1: A caring relationship consists of four phases; preparing for the relationship is part of the pre-interaction phase.

Rationale 2: Although an appropriate nursing intervention for this client, this activity does not necessarily assist in developing a caring relationship.

Rationale 3: A caring relationship consists of four phases; gaining trust is part of the introductory phase.

Rationale 4: A caring relationship consists of four phases; showing respect for a client and his wishes is part of the ongoing maintaining phase.

Rationale 5: A caring relationship consists of four phases; showing concern for a client and his wishes is part of the ongoing maintaining phase.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 06 Describe the four phases of the helping relationship.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Describe the four phases of the helping relationship.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 423

Question 23

Type: MCMA

The graduate nurse is thinking about leaving a new job because of actions demonstrated by the nurse manager. Which actions should the graduate nurse identify as bullying?

Standard Text: Select all that apply.

1. Pairing the graduate with a seasoned nurse to assist with learning new skills

2. Asking the graduate to participate in client rounds with the new interns on the care area

3. Confronting the graduate by stating that refusing an assignment is grounds for dismissal

4. Stating that requests for vacation time will be denied because the nurse asks too many questions

5. Assigning the graduate nurse a complicated client with needs that the graduate is not comfortable performing

Correct Answer: 3, 4, 5

Rationale 1: Pairing the graduate with a seasoned nurse to assist with learning new skills demonstrates supportiveness.

Rationale 2: Asking the graduate to participate in client rounds with the new interns on the care area demonstrates teamwork.

Rationale 3: Confronting the graduate by stating that refusing an assignment is grounds for dismissal is bullying behavior. It is intended to intimidate the graduate.

Rationale 4: Stating that requests for vacation time will be denied because the nurse asks too many questions is bullying behavior. It is intended to humiliate the graduate.

Rationale 5: Assigning the graduate nurse a complicated client with needs that the graduate is not comfortable performing is bullying behavior. It is intended to degrade and undermine, and creates a risk to the safety of a client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A. 9. Discuss principles of effective communication

AACN Essentials Competencies: IX. 4. Communicate effectively with all members of the healthcare team, including the patient and the patients support network

NLN Competencies:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11. Describe the following disruptive behaviors and how they affect the health care environment and client safety: incivility, lateral violence, and bullying.

Outcome: 1.3.1. Apply appropriate communication skills required to conduct the health history interview of a client.

Page Number: 432

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