A patient needs discharge instructions on how to administer heparin. After the nurse demonstrates injection techniques, the patient states, "I need a nurse, I can't do this." Which would be an INAPPROPRIATE response?A) "I can see that you're not trying."B) "Let's talk about how you're feeling."C) "I'll demonstrate as many times as needed."D) "Learning to give an injection may be frightening.
A) "I can see that you're not trying.
The nurse enters a patient's room and states, "You're up early." The patient laughs and replies, "I get up with the chickens." Which action is appropriate?A) Leave the roomB) Laugh with the patientC) Explain that laughter is not allowedD) Indicate that this is an unusual occurrence
B) Laugh with the patientThe power of humor during patient interaction should not be underestimated as an effective communication tool. Laughing is not a reason to leave the room. The statement that laughter is not allowed is not true. This is not an unusual occurrence.
The nurse informs a patient, "I need to attend to another patient urgently. If you don't mind waiting, I will change your clothes at a later time or I can ask someone else to assist you." What kind of communication does the statement made by the nurse indicate?A) Assertive communicationB) Aggressive communicationC) Unassertive communicationD) Non-therapeutic communication
A) Assertive communicationThe patient is informed that the nurse has to attend to an urgent situation; this information is conveyed in a polite manner without disturbing the patient's feelings. This type of communication is referred to as assertive communication. Aggressive communication is a type of communication in which one person tries to overpower another. In this situation, the nurse is not trying to be authoritarian. In non-assertive communication, a person uses vague statements that may be difficult for the other members to understand. Non-therapeutic communication is a type of communication that hampers the development of the nurse-patient relationship.
A nurse is attempting to interview a patient who speaks a different language. The family member is the only person in the clinic who can translate; an interpreter is not available. In an effort to collect the needed data, what is the best strategy the nurse can use?A) Reschedule the interview for when a medical translator is available.B) Have the patient point to pictures that describe signs and symptoms.C) Use the family member as the translator while conducting the interview.D) Ask closed-ended questions to make communication easier for everyone.
C) Use the family member as the translator while conducting the interview.Language barriers can pose a major threat to effective communication and the development of a therapeutic nurse-patient relationship. If an interpreter cannot be found, the nurse can use the family member or friends to assist with communication. Postponing the interview can prolong needed care. Pointing to pictures may not convey true symptoms a patient may have. Asking closed-ended questions is insufficient because the patient does not understand the nurse's language.
What interventions should the nurse take while caring for a comatose patient? Select all that apply.A) Talk to the patient about daily activities.B) Encourage the family members to talk to the patient.C) Explain the activity or procedure that involves the patient.D) Ask the family to talk about instances of illness or accidents.E) Discuss the patient's health status in the patient's presence.
A) Talk to the patient about daily activities.B) Encourage the family members to talk to the patient.C) Explain the activity or procedure that involves the patient.A comatose patient is usually unresponsive to any stimulus, but there have been instances in which patients recall the conversations made while comatose; therefore, there are chances the patient hears all that is said. The nurse should encourage family members to talk to the patient, because it may trigger a response in the patient. Talking about daily activities is beneficial to the patient, because the patient may hear and be kept aware of all developments. Involving the patient while engaged in an activity may make the patient feel normal, which is beneficial to the patient. Talking about illnesses or accidents responsible for the coma aggravates fear in patient, and should be avoided. Discussing the patient's health status in the patient's presence may cause anxiety and depression in the patient and may negatively affect the patient's health.
A nurse has been interviewing a patient for over an hour. To ensure that important information was collected, the nurse should use which communication technique?A) TouchB) HumorC) SilenceD) Summarizing
D) SummarizingSummarizing provides a review of the main points covered during interaction. In this case, the interview has been ongoing for the past hour and much has been discussed. Summarizing gives the interviewer one last opportunity to ensure that the important information that can affect the plan of care has been received. Touch, humor, and silence, although positive, are inappropriate at this time.
A nurse demonstrating caring, sincerity, empathy, and trustworthiness is considered to be engaging in what type of relationship?A) VerbalB) NourishingC) NonverbalD) Therapeutic
D) Therapeutic
A terminally ill patient has just died. The family members are upset and crying. What is the most appropriate action the nurse can take to convey support and compassion?A) Ask the family to leave, then provide postmortem care.B) Stay with the family and use silence and therapeutic touch.C) Immediately leave the room and allow the family to grieve.D) Begin to make funeral arrangements so the family can give approval.
B) Stay with the family and use silence and therapeutic touch.An example of effective use of silence is when a patient dies. The nurse can communicate support and compassion by remaining with the family. Allowing the family time to express their feelings while the nurse remains silent and using therapeutic touch communicate that the nurse cares for the family without trying to talk away the situation. Asking the family to leave, leaving, or making funeral arrangements at this point is inappropriate.
The nurse is caring for a patient on mechanical ventilation. The nurse learns that the patient is illiterate. What methods of communication should the nurse use while communicating with the patient? Select all that apply.A) Eye blinkB) Magic slateC) Picture boardD) Sign languageE) Magnetic boards
A) Eye blinkC) Picture boardD) Sign languageThe patient on mechanical ventilation will be unable to speak due to the endotracheal tube. Eye blinking is an alternate method of communication in which the patient is told to use a signal system such as one eye blink for "yes" and two for "no." A picture board is a medium of communication by which the patient communicates by selecting pictures. Indicating something or using gestures is also a way to communicate nonverbally. The magic slate is a board on which the patient writes messages to communicate needs; because the patient is illiterate, this method of communication cannot be used. A magnetic board is a board with letters the patient moves to spell words or phrases, but cannot be used in this case used because the patient is illiterate.
During the interview the patient states, "I am so depressed and confused." What would be the most appropriate reply the nurse can give?A) "Depression can be confusing."B) "You are depressed and confused?"C) "Is your depression causing confusion?"D) "How is the confusion causing depression?
B) "You are depressed and confused?"Restating to the patient what is believed to be the main point that the patient is trying to make is restating. When the nurse simply repeats the patient's comment, the patient is encouraged to open up further and provide more information. If made, the other statements could cause further misunderstanding.
The nurse is communicating with a patient who lives next door to the nurse. How can the nurse maintain the social distance while communicating with the patient?A) Ask open-ended questions to the patient.B) Keep 4 to 12 feet distance between them.C) Maintain direct eye contact with the patient.D) Keep 18 inches to 4 feet distance between them.
B) Keep 4 to 12 feet distance between them.The norm for social distance is 4 to 12 feet with acquaintances. This social factor is different for each culture. Open-ended questions encourage the patient to talk and express concerns; it is not related to social distance. Maintaining direct eye contact with the patient helps in building trust, but is not related to social distance. Keeping 18 inches to 4 feet distance in between themselves and a new acquaintance is called personal space.
A Native American patient comes to the emergency center. A culturally sensitive nurse would limit eye contact based on what principle?A) It indicates an intent to communicateB) Eye contact would indicate sexual advances.C) Eye contact indicates a desire for confrontation.D) Eye contact is perceived as impolite, aggressive, and improper.
D) Eye contact is perceived as impolite, aggressive, and improper.Some cultures such as Arabic or Native American cultures view eye contact as impolite, aggressive, or improper. Eye contact generally indicates intent to communicate, not sexual advances or a desire for confrontation.
Therapeutic communication is a key to providing the best care possible to patients. Identify the factors that negatively affect therapeutic communication. Select all that apply.A) Lack of trustB) Language barrierC) Indifferent attitudeD) Cultural differencesE) Use of active listening
A) Lack of trustB) Language barrierC) Indifferent attitudeD) Cultural differencesLanguage differences between the nurse and patient, an indifferent attitude from a nurse, a lack of trust between nurse and patient, and cultural differences all negatively affect therapeutic communication.
Every individual has his or her own set of boundaries for personal space. Which example best explains a nurse's respect for personal space?A) The insertion of a Foley catheter using sterile techniqueB) Talking to a group of patients from the front of a classroomC) Sitting in a chair beside the patient's bed with good eye contactD) Standing at the door and asking the patient what he or she had for breakfast
C) Sitting in a chair beside the patient's bed with good eye contactPersonal space or zone is 18 inches to 4 feet; therefore this example falls within those boundaries.
The nurse is communicating with a hearing-impaired patient. Which techniques should the nurse use for effective communication? Select all that apply.A) Use short and simple sentences.B) Avoid shouting at the patient.C) Speak directly into the patient's ear.D) Maintain the voice pitch at mid-range.E) Give the person time to respond to questions.
A) Use short and simple sentences.B) Avoid shouting at the patient.D) Maintain the voice pitch at mid-range.E) Give the person time to respond to questions.While communicating with the hearing-impaired person, care should be taken so that the patient understands the message. Some techniques promote comprehension for the patient. Using short and simple sentences makes it easy for the patient to understand. Shouting can distort speech; therefore, the nurse should avoid shouting at the patient. Maintaining voice pitch at mid-range helps the patient to hear clearly. Giving the person time to respond to questions helps the nurse to understand whether the patient has understood or not. Avoid speaking directly into the patient's ear. It can distort the message and hide all visual cues.
A nurse is caring for a patient. Which type of communication can the patient use to express anxiety and fear?A) VerbalB) NonverbalC) IntonationD) Active listening
B) NonverbalAnxiety and fear are expressed using nonverbal cues. Nonverbal forms of communication involve body language. The patient expresses anxiety and fear through body movement or activities. Verbal communication happens through spoken words and sentences. Intonation is a characteristic of nonverbal communication. Active listening is an important factor required for good communication; however, it is not related to the expression of anxiety and fear.
A nurse is collecting data from a patient with a sexually transmitted disease. When asked about partners, the patient states, "There have been so many I lost count." Which statement made by the nurse conveys acceptance?A) "Having intercourse with that many partners is the reason you have this dirty disease."B) "That statement is not funny and it is inappropriate given the current circumstances."C) "Let's identify as many partners as possible so that they can get the treatment needed."D) "For once in your life you need to think about the innocent people you may have infected.
C) "Let's identify as many partners as possible so that they can get the treatment needed."Some patients are hesitant to give the nurse complete information, particularly because it relates to values, beliefs, lifestyles, and practices. Often this reluctance arises from fear of disapproval from the nurse with regard to the patient's values, beliefs, lifestyle, and practices, or even rejection of the individual as a person. The nurse's willingness to listen and respond to what the patient is saying without passing judgment on the patient is the key to the development of the therapeutic relationship. Working with the patient to find the sexual partner(s) conveys to the patient a feeling of acceptance and the willingness to help.
Which nonverbal clue would send a negative message to a patient?A) Relaxed stanceB) Crossed arms, legsC) Facing an individualD) Direct eye contact
B) Crossed arms, legsThe way one sits, stands, and moves is posture. Posture has the ability to convey warmth and acceptance, as well as distance and disinterest. Crossed arms and legs are considered closed posture and create a more formal distance. People usually interpret this as disinterest, coldness, and nonacceptance. A relaxed stance while facing an individual and direct eye contact are open postures, equivalent to warmth and acceptance.
Which statement by the LPN is an example of using assertiveness?
It is time for you to go to physical therapy (PT). Do you want to walk part way or do you think you're strong enough to walk all the way?
Which nonverbal communication technique is therapeutic and effective but requires practice and a conscious effort by the nurse to use successfully?
B) Silenceand timing. Listening, touch, and conveying acceptance are nonverbal therapeutic communications, but they do not always require a conscious effort for use.
Good communication skills help obtain detailed information about the patient. Which characteristics of communication help in effective patient care? Select all that applyA) FeedbackB) ValidationC) ExpressionD) IntonationE) Active listening
A) FeedbackB) ValidationE) Active listeningGood communication plays a vital role in a patient-nurse relationship. It requires feedback, validation, and active listening. Timely feedback ensures correct interpretation of the message. Validation ensures that nonverbal cues are correctly assumed. Active listening focuses on what is being said. Expression and intonation are characteristics of nonverbal communication.
A nurse touches a patient warmly on the shoulder and states that it is good that the medicines have relieved his pain. What does this indicate?A) CaringB) FocusingC) ReflectionD) General leads
A) CaringTouch indicates caring. Messages accompanied by touch add feelings of caring and comfort. Focusing involves goal-directed questions. The reflection technique involves reflecting received messages back to the patient. The general leads provided by the nurse encourage the patient to continue or to elaborate.
A nurse is attempting to interview a patient in severe pain. In an effort to promote communication, what is the best action the nurse can take?A) Postpone the interview until the pain is manageable.B) Address the pain and then proceed with the interview.C) Ask the patient to ignore the pain during the interview.D) Promise the patient pain medication after the interview.
B) Address the pain and then proceed with the interview.Many physiologic factors may interfere with the patient's ability to communicate effectively. When a patient is experiencing pain, it is impossible for the patient to focus on anything other than the pain. The nurse should address the pain before trying to communicate with the patient.
What is essential for the nurse to establish before a therapeutic relationship forms?A) TrustB) BeliefC) LoyaltyD) Content
A) TrustIf the patient senses that the nurse is not being genuine in conveying feelings, a therapeutic trusting relationship does not develop. Loyalty, contentment, and belief are not essential or fundamental to the therapeutic relationship.
A patient arrives at the emergency room with respiratory distress. The nurse needs to get essential information for the planning of the patient's care. Based on the patient's condition, what should the nurse do?A) Offer informationB) Ask open-ended questionsC) Begin a detailed interview D) Ask closed-ended questions
D) Ask closed-ended questionsClosed-ended question focus on seeking a particular answer and require a one- or two-word response, which is appropriate for a patient who is in respiratory stress. The goal is to get information that is essential for the development of the patient's plan of care. Offering information before the problem is identified is inappropriate. Asking open-ended questions and performing a detailed interview are not recommended because the patient's condition may be life-threatening.
A patient is scheduled for chemotherapy. The nurse asks the patient whether he or she has any questions about chemotherapy. Which type of technique is used by the nurse?A) FocusingB) ReflectionC) General leadsD) Restatement
A) FocusingThe nurse asks a goal-directed question to help the patient focus on key concerns. In the reflection technique, reflecting the received message back to the patient helps the patient understand his or her own thoughts. General leads encourage the patient to continue to elaborate on the topic. In the restatement technique, the nurse rephrases the same message and repeats it back to the patient.