A client asks for advice regarding a personal problem. Which is the most appropriate response by the nurse?
Ask the client what would be the best thing to do.
A client has difficulty communicating verbally (expressive aphasia) because ofa brain attack (stroke). Which should the nurse do when caring for this client? Select all that apply.
Teach the client how to use a picture board.
Encourage the client to elaborate with gestures.
Be patient when the client is attempting to speak.
A client is admitted to the hospital with multiple health problems. Which nursing intervention is least effective in meeting the client's psychosocial needs?
Assisting the client with meals.
A client is being discharged to a nursing home. While preparing the discharge summary, the client says, "I feel that nobody cares about me." Which is the nurse's best response?
You feel as if nobody cares
A client is confused and disoriented. Which route of communication used by the nurse is most effective in this situation?
Touch
A client is upset and rambles about an incident that occurred earlier in the week. Which should the nurse do first?
Identify the client's concerns.
A client tells the nurse, "The doctor just told me I have cancer" and then begins to cry. Which is the best response by the nurse?
Sometimes it helps to talk about it
A client who is hearing impaired tells the nurse, "I have difficulty hearing what people say to me." Which should the nurse do? Select all that apply.
Face the client directly when talking
Provide pencil and paper for communication
Emunciate clearly when speaking with the client
A client who usually is verbal appears sad and withdrawn. Which should the nurse do? Select all that apply.
Use open-ended questions
Describe the behavior to the client
A client's son has just died. The client states, "I can't believe that I have lost my son. Can you believe it?" Which is the nurse's best response?
Touch the client's hand and say, "I am very sorry
A client's spouse died I week ago. When reminiscing about their life together, the client begins to cry. Which is the nurse's best response?
Say, "This must be a very difficult time for you
A dying client is withdrawn and depressed. Which are the most therapeutic actions by the nurse? Select all that apply.
Accepting the client's behavioral response
Telling the client you are available to talk
A dying client says to the nurse, "I was much more religious when I was young." How should the nurse respond to the client's statement?
Would you like me to call a chaplain?
A newly admitted client appears upset and agitated. Which should the nurse do to best assist this client?
Encourage the client to share feelings
A nurse identifies that a usually talkative client is withdrawn. Which is the nurse's best response?
You are very quiet today
A nurse is conducting an intake interview with a client. Which should the nurse do to best facilitate therapeutic communication with this client?
Listen attentively
A nurse is performing a self-appraisal concerning the use of statements that do not support a client's needs. Which statements by the nurse are nontherapeutic? Select all that apply.
This is minor surgery
A lot of people hate injections
You'll walk better after you have physical therapy
An older adult reminisces extensively and attempts to keep the nurse from leaving the room. Which nursing action is a therapeutic response?
Setting aside time to listen to the stories about the client's past
Several times a day, every day, a client who is experiencing short-term memory loss asks when medication is to be given. The client receives medication at the same time every day. Which is the most therapeutic nursing intervention?
Make the client a sign to hang on a wall indicating the times for medication.
Which concepts are important for the nurse to consider when interacting with others? Select all that apply.
Personal appearance can be a source of information about a person.
Touch has various meanings to different people.
A client reports a pain rating of 9 on a scale of 1 to 10. The nurse administers an intravenous narcotic analgesic to the client. What will the nurse include when documenting this task? Select All That Apply.
Location and characteristics of the pain
Client's pain level 30 to 60 minutes after the medication is given
At which points of client care must the nurse complete a discharge summary? Select All That Apply.
Moved to an acute rehabilitation unit
Transferred to a long-term skilled facility
Allowed to leave the hospital and go home
How often must a long-term care facility complete the Minimum Data Set for Resident Assessment and Care Screening (MDS) after initial admission?
Every 3 months
Which are examples of appropriate medication orders? Select all that apply.
Aspirin 325 mg by mouth every morning
Rocephin 200 mg IV q6h
Ibuprofen 200 mg q4h prn fever or mild pain
Which techniques are barriers to communication with clients? Select All That Apply.
Expressing approval
Providing false hope
Asking "why" questions
Interpreting body language
Which phase of the nurse-client relationship allows the client to express thoughts and feelings to the nurse?
Working phase
A nurse is learning about various communication concepts and techniques. Which statement by the nurse is correct about intrapersonal communication?
An internal dialogue is known as self-talk.
Verbal communication is a key process for caring for clients. Verbal communication consists of which factors? Select all that apply.
Vocabulary
Pacing and rhythm
Timing and relevance
When communicating with a client who is not fluent in English, what should the nurse do?
Contact interpreter services for a translator who speaks the client's language.
What does the "Q" refer to in the SBARQ communication tool?
Questions
In a PIE charting format, what does the "P" identify?
Nursing diagnosis
Which behaviors should the nurse include when actively listening to a client? Select All That Apply.
Focus on nonverbal behaviors.
Face the client and lean in.
Sit at the eye level of the client.
c is a standardized communication tool utilized between nurses and other health-care providers when there is a change in a client's condition. Which statement presents the background information?
Mrs. Smith has a respiratory rate of 36 breaths per minute, her oxygen saturation is 91% on room air, and she has crackles in the left lower lung.
The nurse is preparing to administer an insulin injection to a client with an elevated blood glucose level. What should the nurse check in the electronic medication administration record prior to giving the dose?
Location of last injection
Which information should always be included in a report in which a client is transferred from one unit to another? Select all that apply.
Client's name, age, and diagnosis
Last set of vital signs
Tubes, lines, or IV therapy
Which type of communication is a nurse most likely to inadvertently utilize when working with an 84-year-old client who is of the same cultural background as the nurse, and is being seen in the clinic for a follow-up visit for a sprained wrist?
Elderspeak
There are several communication styles that can interfere with therapeutic relationships. What are the characteristics of a passive style?
To avoid conflict and let others take the lead
The nurse uses the SOAP format for documentation and types in a client's medical record, "The left coccyx wound is reddened and measures 1 cm x 2 cm x 0.2 cm and is without drainage." Which aspect of the SOAP format is this considered?
Objective
Under what circumstances should documentation occur prior to a procedure being done?
Charting ahead should never be done
Which is an example of interpersonal communication?
Three nurses discussing the client's plan of care
The nurse is working with parents of a client recently diagnosed with cystic fibrosis, and they tell the nurse they fear the child will not have a normal life. Which statement made by the nurse indicates the use of restating?
I understand your concern that your child may not live a normal life. More adults with cystic fibrosis have more normal lives as there are new treatments that prolong and improve quality of life.
A new nurse is learning how to communicate assertively. Which is an example of ineffective communication by the nurse?
Why haven't you ordered Mr. Smith's pain medication yet?
The nurse educator is preparing a class for new graduate nurses about barriers to therapeutic communication. What do the barriers include? Select all that apply.
Asking too many questions
Asking "why"
Changing the subject inappropriately
Offering advice
Providing false reassurance
What are the characteristics of a successful group? Select all that apply.
Shared leadership and responsibility
Cohesive climate
Mutual trust
Shared set of guidelines for functioning
Willingness to change what is not working
Which is a definition of a therapeutic relationship?
A relationship that focuses on improving the health of the client, whether an individual or community
The nurse is teaching the client about his upcoming procedure and the client is very stressed. what is most important for the nurse to do?
Determine if the teaching should take place at a different time
Use of the statements "Tell me more about..." or "I see" encourages clients to continue talking and expressing themselves. This is called
Encouraging eleboration
SBAR
situation
background
assessment
recommendation