General Psychology - Exam View

Communication and the Nurse-Patient Relationship Williams: deWit's Fundamental Concepts and Skills for Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse can best ensure that communication is understood by: a. speaking slowly and clearly in the patient’s native language. b. asking the family members whether the patient understands. c. obtaining feedback from the patient that indicates accurate comprehension. d. checking for signs of hearing loss or aphasia before communicating. ANS: C The best way to determine understanding is to ask the patient. Factors such as anxiety, hearing acuity, language, aphasia, or lack of familiarity with medical jargon or routines can all contribute to misunderstanding. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #1 TOP: Feedback KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 2. The nurse recognizes a verbal response when the patient: a. nods her head when asked whether she wants juice. b. writes the answer to a question asked by the nurse. c. begins sobbing uncontrollably when asked about her daughter. d. is moaning and restless and appears to be in pain. ANS: B Verbal communication involves words, either written or spoken. Nodding, sobbing, and moaning are nonverbal communication. DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #1 TOP: Verbal Communication Feedback KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 3. The nurse recognizes the patient who demonstrates communication congruency when the patient: a. smiles and laughs while speaking of feeling lonely and depressed. b. wrings her hands and paces around the room while denying that she is upset. c. is tearful and slow in speech when talking about her husband’s death. d. states she is comfortable while she frowns and her teeth are clenched. ANS: C Congruent communication is the agreement of verbal and nonverbal messages. DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #1 TOP: Congruence KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 4. A Hispanic patient approaches the Asian nurse and, standing very close, touches the nurse’s shoulder during their conversation. The nurse begins to step back to 18 to 24 inches, while smiling and nodding to the patient. This situation is most likely an example of: a. the nurse’s need to maintain a professional role rather than a social role. b. a patient’s attempt to keep the nurse’s attention. c. a nurse’s need to establish a more appropriate location for conversation. d. a difference in culturally learned personal space of the nurse and the patient. ANS: D Personal space between people is a culturally learned behavior; Asians, North American natives, and Northern European people generally prefer more personal space than people of Hispanic, Southern European, or Middle Eastern cultures. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #2 TOP: Cultural Differences KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 5. A nurse says to a patient, “I am going to take your TPR, and then I’ll check to see whether you can have a PRN analgesic.” In considering factors that affect communication, the nurse has: a. used terminology to clearly inform the patient of what she is doing. b. given information that is unnecessary for the patient to know. c. used medical jargon, which might not be understood by the patient. d. taken into consideration the patient’s need to know what is happening. ANS: C Medical jargon such as abbreviations or medical terminology is often misunderstood, even by well educated people. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #3 TOP: Blocks to Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 6. A nurse using active listening techniques would: a. use nonverbal cues such as leaning forward, focusing on the speaker’s face, and slightly nodding to indicate that the message has been heard. b. avoid the use of eye contact to allow the patient to express herself without feeling stared at or demeaned. c. anticipate what the speaker is trying to say and help the patient express herself when she has difficulty with finishing a sentence. d. ask probing questions to direct the conversation and obtain the information needed as efficiently as possible. ANS: A Eye contact is a culturally learned behavior and in some cases may not be appropriate. Probing questions or finishing the patient’s sentence is not part of active listening and is detrimental to an interview. DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: Theory #3 KEY: Nursing Process Step: Implementation TOP: Active Listening MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 7. When the patient says, “I don’t want to go home,” the nurse’s best therapeutic verbal response would be: a. “I’m sure everything will be fine once you get home.” b. “You don’t want to go home?” c. “Doesn’t your family want you to come home?” d. “I felt like that when I had surgery last year.” ANS: B The use of reflecting encourages the patient to expand on his or her feelings or thoughts. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Table 8-1 Theory #3 TOP: Communication Techniques Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 8. To begin talking with a newly admitted patient about pain management, the nurse would most appropriately state: a. “You look pretty comfortable. Are you having any pain?” b. “Tell me about the pain you’ve been having.” c. “Is this pain the same as the pain you had yesterday?” d. “Don’t worry; this pain won’t last forever.” ANS: B An open-ended question allows the patient to express his or her feelings or needs. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Table 8-1 Theory #3 TOP: Communication Techniques Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 9. When a patient begins crying during a conversation with the nurse about the patient’s upcoming surgery for possible malignancy, the nurse’s most therapeutic response would be: a. “Your surgeon is excellent, and I know he’ll do a great job.” b. “Oh, dear, your gown is way too big, let me get you another one.” c. “Don’t cry; think about something else and you’ll feel better.” d. “Here is a tissue. I’d like to sit here for a while if you want to talk.” ANS: D Offering self, or presence, and accepting a patient’s need to cry is supportive. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Table 8-1 Theory #3 TOP: Therapeutic Techniques Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 10. To enhance the establishment of rapport with a patient, the nurse should: a. identify himself by name and title each time he introduces himself. b. share his own personal experiences so that the patient gets to know him as a friend. c. act in a trustworthy and reliable manner; respect the individuality of the patient. d. share information with the patient about other patients and why they are hospitalized. ANS: C Trust and reliability, as well as conveying respect for the individual, all promote rapport. Identifying oneself is important but in itself does not promote rapport. Sharing personal experiences or divulging the confidential nature of other patients’ conditions is not appropriate in the nurse-patient relationship. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 111 TOP: Rapport Clinical Practice #2 Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 11. The nurse explains that the therapeutic nurse-patient relationship differs from the social relationship because: a. a social relationship does not have goals or needs to be met. b. the nurse-patient relationship ends when the patient is discharged. c. the focus is mainly on the nurse in the nurse-patient relationship. d. a social relationship does not require trust or sharing of life experiences. ANS: B The nurse-patient relationship is limited to the patient’s stay in the facility and is focused on the patient. A social relationship may have goals or needs and does require trust and sharing of life experiences. DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: Theory #4 TOP: Relationships KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 12. The nurse has selected an outcome for the patient to eat all of the food on the breakfast tray each day. Assessing that the patient has eaten all of the breakfast, the nurse would give positive feedback by saying: a. “Wow! That breakfast must have been pretty good.” b. “I like pancakes too. Everyone on the hall seemed to enjoy them.” c. “I hope you can keep all that breakfast down.” d. “Hurray! You finished your whole meal! What would you like for tomorrow?” ANS: D Giving positive feedback increases the likelihood of the desired behavior to be repeated. Commenting on the tastiness of the food or the fact that others liked it is not responding directly to the patient’s having eaten the whole meal. DIF: Cognitive Level: Application REF: p. 102 OBJ: Theory #9 TOP: Positive Feedback KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 13. A 67-year-old woman had major abdominal surgery yesterday. She has IV lines, a urinary catheter, and an abdominal wound dressing, and she is receiving PRN pain medication. The end of shift report that best conveys the patient status is: a. “Doing great, was up in the chair most of the day. No complaints of pain or discomfort. Voiding adequately.” b. “Abdominal surgery yesterday, dressing is dry and intact, her IVs are on time and she’s had pain meds twice. Vital signs stable.” c. “Abdominal dressing dry, IVs—800 mL left in #6; NS running at 125 mL/hr; urine output 800 mL this shift; had morphine 15 mg for pain at 8:00 AM and at 1:30 PM. She’s comfortable now. Vital signs are stable, no fever.” d. “Unchanged since this morning. She wanted to know how soon she can have something to eat, so maybe you could check with her doctor this evening. Her husband has been visiting all day and will let you know if she needs anything.” ANS: C This brief clear report addresses the major concerns of the abdominal dressing, the status of the IV fluids, vital signs, and analgesia needs. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 115|Box 8-2 Clinical Practice #4 TOP: Shift Report Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment: Coordinated Care 14. An aspect of computer use in patient care in which the LPN may need to be proficient includes: a. input of data such as requests for radiographs or laboratory services. b. programming the computer to record data from primary care provider and other health care workers. c. educating patients how to use hospital computers to access information such as discharge instructions or information relative to specific medications. d. scheduling admissions, discharges, and nurse staffing to keep the unit at the best occupancy and utilization. ANS: A Facilities use computers for data entry relative to requesting radiograph, laboratory services, physical assessment and medication administration. Programming such computers is not a nursing task and patients need to have individualized information about discharge and medications. DIF: Cognitive Level: Knowledge TOP: Computer Use MSC: NCLEX: N/A REF: p. 117 OBJ: Theory #8 KEY: Nursing Process Step: Implementation 15. A patient with a nursing diagnosis of Sensory perception, disturbed auditory, would most appropriately require the nurse to: a. obtain a sign language interpreter when a family member is unavailable. b. speak slowly and distinctly, but not shout. c. provide bright lighting without glare and orient frequently. d. reorient frequently to time, place, staff, and events. ANS: B A patient with disturbed auditory perception cannot hear well (or at all); therefore, speaking slowly and distinctly without shouting increases patient comprehension. DIF: OBJ: TOP: KEY: MSC: Cognitive Level: Application REF: p. 111 Clinical Practice #3 Hearing Impaired Patient Communication Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 16. When an office nurse asks the patient to repeat information that he has just given to the patient over the telephone, the nurse is: a. testing the patient’s intelligence and memory. b. acting in a cautious way to avoid charges of negligence. c. verifying that the patient understands the information. d. saving the extra time it would take to mail the information. ANS: C Obtaining feedback from a patient to ascertain that the patient understands instructions is an important part of the communication process, especially over the phone, when the nurse does not have nonverbal cues. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #3 TOP: Telephonic Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 17. A 36-year-old woman who is in traction for a fractured femur that she received in an auto accident is found crying quietly. The nurse can best address this situation by saying: a. “What’s the matter? Why are you crying? Are you in pain?” b. “Stop crying and tell me what your problem is.” c. “This could have been much worse. You’re lucky no one was killed.” d. “You are upset. Can you tell me what’s wrong?” ANS: D The nurse offers a general lead as to what is causing the distress. The other options are judgmental or clichéd or offer no opportunity for the patient to express feelings. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Table 8-1 Theory #3 TOP: Reflecting Observations Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 18. When the nurse is giving direction to a nursing assistant who is being delegated part of the patient care, the nurse’s most effective direction would be: a. “Do the morning care first on the patients in 205 and 206 who can’t get out of bed.” b. “You take care of all the patients in 205 and 206. Let me know how you’re doing and whether you need any help.” c. “Give the patient in 204A a shower after breakfast, and call me to check her feet before you get her dressed.” d. “Take the vital signs on all the patients in the lounge and tell me whether there are problems.” ANS: C The clarity and brevity of the direction makes the delegated task clear and leaves the responsibility of assessment to the nurse. DIF: Cognitive Level: Application REF: p. 115 OBJ: Theory #7 TOP: Delegation KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 19. When the patient says, “I get so anxious just lying here in this hospital bed. I have a million things I should be doing at home,” the most empathetic response would be: a. “I’d feel the same way you do. I know just what you’re going through.” b. “It sounds like you’re having a tough time dealing with this situation.” c. “It’s always darkest before the dawn. Hang in there; it will get better.” d. “You sound pretty sorry for yourself. Why don’t you look at the positives?” ANS: B Empathy recognizes a patient’s situation and encourages expression of feelings. DIF: Cognitive Level: Application REF: p. 111 OBJ: Theory #3 TOP: Empathy KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 20. A patient asks the nurse, “What would you do if you had cancer and had to choose between surgery and chemotherapy?” The reply that can best help the patient is: a. “If I were you, I would choose surgery and then consider chemo afterward.” b. “What solutions have you considered?” c. “I would talk it over with my friends first.” d. “I don’t know. I’m glad it isn’t my decision.” ANS: B Nurses can help by reminding patients of alternatives open to them and should refrain from giving advice but can encourage the patient to consider options. The nurse may be glad not to face a decision a patient must, but it is not helpful to the patient to say this. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Table 8-1 Theory #3 TOP: Offering Alternatives Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 21. The nurse chooses to use touch in the nurse-patient relationship because touch: a. can convey caring and support when words are difficult. b. should be avoided because of problems of cultural misinterpretation. c. is appropriate only in special circumstances, such as with young children. d. is a nursing intervention of choice in almost all situations. ANS: A Touch is a powerful and supportive nonverbal communication in many situations. It is appropriate for all ages, but not in some situations. Careful assessment of the patient’s situation and cultural values should determine its use, but it should not be avoided because of stereotypes. DIF: Cognitive Level: Comprehension REF: p. 106 OBJ: Theory #4 KEY: Nursing Process Step: Implementation TOP: Caring Touch MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 22. When the nurse makes the statement, “We can come back to that later—right now I need to know about when your symptoms started,” the nurse is: a. letting the patient know that topic of conversation was inappropriate. b. setting limits on the expression of feelings. c. refocusing the patient to the issue at hand when the conversation has wandered. d. closing off the conversation by quickly getting to the point of the interview. ANS: C Refocusing is often necessary to accomplish data collection. It does not block communication and is not used to close a conversation or stop an inappropriate topic. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #3 TOP: Refocusing Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 23. A patient who has had a stroke is unable to speak clearly and has right sided hemiplegia. The nurse will design the approach to the assessment interview by: a. asking questions and explaining procedures to the patient’s daughter. b. speaking slowly and giving the patient time to respond. c. telling the patient he will get all necessary information from the daughter. d. prompting the answers and finishing the sentences for the patient. ANS: B Speaking slowly recognizes that the patient may process (if able) information more slowly. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Box 8-1 Clinical Practice #3 TOP: Impaired Communication Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 24. When a nurse is conducting an assessment interview, the most efficient technique would be: a. explaining the purpose of the interview. b. excluding relatives and friends from the interaction. c. telling the patient what data are already available. d. asking closed questions to obtain essential information. ANS: D Closed questions have a definite place when the nurse wants to obtain specific essential data. Closed questions force the patient to stick to the topic. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 106 TOP: Interview Clinical Practice #1 Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 25. While interviewing a Native American man for the admission history, the nurse should expect to: a. wait patiently through long pauses in the conversation. b. maintain eye contact with the patient. c. give the patient permission to speak. d. have another family member speak for the patient. ANS: A Native Americans use long pauses in their conversation to better consider their answer and consider the question. The culturally sensitive nurse would wait quietly through the pauses. DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: Clinical #1 TOP: Cultural Considerations KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 26. The nurse is aware that the purpose of therapeutic communication is to: a. gather as much information as possible about the patient’s problem. b. direct the patient to communicate about his deepest concerns. c. focus on the patient and the patient needs to facilitate interaction. d. gain specific medical information and history of illness. ANS: C Therapeutic communication is a conversation that is focused on the patient and promotes understanding between the sender and the receiver. DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: Theory #4 TOP: Therapeutic Communication KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 27. The practical nursing student who is engaged in a therapeutic communication with a patient will have the most difficulty with the technique of: a. closed questions. b. restating. c. using general leads. d. silence. ANS: D The use of silence is the hardest for most students to develop because it makes them uncomfortable, so they tend to end it prematurely. DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: Theory #31 TOP: Silence KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 28. To convey the intervention of active listening, the nurse would: a. maintain eye contact by staring at the patient. b. prompt the patient when the patient stops talking for a moment. c. make a conscious effort to block out other sounds in the immediate environment. d. write down remarks on a clipboard to facilitate later topics of conversation. ANS: C An active listener maintains eye contact without staring, gives the patient full attention, and makes a conscious effort to block out other sounds and distractions. DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: Theory #3 TOP: Active Listening KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 29. When the nurse enters the room, the patient is laughing out loud at something on TV. The patient stops and apologizes for the laughter, saying, “I guess I ought not be laughing at all since I am stuck here with two broken legs.” The nurse can use evidence-based information when she responds: a. “Laughter is nearly always a cover up for anxiety when facing a long rehabilitation.” b. “Long periods of laughter decrease the amount of oxygen available to your body for healing.” c. “Laughter in a hospital is often distracting and depressing to other patients nearby.” d. “Laughter truly is the best medicine as it has a positive effect on the immune system.” ANS: D Hasen and Hasen (2009) found that laughter and appropriate use of humor decreased stress and anxiety and had a positive effect on the immune system. DIF: Cognitive Level: Application REF: p. 104 OBJ: Clinical #2 TOP: Use of Laughter KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 30. When interacting with an older adult patient, the nurse would enhance communication by: a. speaking slowly in order to allow the patient to process the message. b. addressing him by his first name to encourage a therapeutic relationship. c. standing in the doorway rather than entering the room to give the older adult patient more privacy. d. speaking in simple sentences, as if to a child. ANS: A When interacting with an older adult, the nurse should try not to speak too quickly or expect an immediate answer because the older adult may take more time to process the message. Do not use baby talk or speak to them as if they were children. DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: Theory #2 KEY: Nursing Process Step: Implementation TOP: Communication MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 31. When the nurse observes a resident in a long-term facility pounding his fists on his legs and grinding his teeth, the nurse will validate her perception of the patient’s nonverbal expression of anger by: a. documenting that the patient was agitated and appeared angry. b. asking the male nursing assistant if it is his perception that the patient appears angry. c. accessing the nursing care plan to ascertain if there is a nursing diagnosis relative to anger. d. sitting down near the patient and saying, “You seem upset…can I help?” ANS: D All perceptions based on the observation of nonverbal behavior should be validated by consulting the patient. DIF: TOP: KEY: MSC: Cognitive Level: Application REF: p. 102 Validating Perceptions Nursing Process Step: Assessing Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation OBJ: Theory #9 32. When a patient states, “I don’t feel like walking today,” the nurse’s most therapeutic verbal response would be: a. “You have to walk today.” b. “You don’t want to walk today?” c. “I don’t feel like walking today either.” d. “Why don’t you want to walk today?” ANS: B Reflection is a way to restate the message. The idea is simply reflected back to the speaker in a statement to encourage continued dialogue on the topic. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Table 8-1 Theory #3 TOP: Communication Techniques Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 33. When a patient states, “My son hasn’t been to see me in months,” the nurse’s best verbal response is: a. “Don’t worry; I’m sure your son will visit.” b. “Your son hasn’t been around much lately?” c. “My son doesn’t come to visit me either.” d. “How terrible that he doesn’t visit you.” ANS: B Restating in different words what the patient said encourages further communication on that topic. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: p. 105|Table 8-1 Theory #3 TOP: Communication Techniques Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 34. An example of a nurse communicating with a patient using open-ended questions would be: a. “Is your pain less today than it was yesterday?” b. “Did you sleep all night without waking?” c. “How many bowel movements have you had today?” d. “What was your daughter’s reaction to your desire for hospice?” ANS: D An open-ended question is broad, indicating only the topic, and it requires an answer of more than a word or two. Use of an open-ended question or statement allows the patient to elaborate on a subject or to choose aspects of the subject to be discussed. Open-ended questions or statements are helpful to open up the conversation or to proceed to a new topic. They usually cannot be answered with one word or just “yes” or “no.” DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 105|Table 8-1 Theory #3 TOP: Communication Techniques Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 35. The nurse tells a patient, “For the last 2 days we have talked about whether to notify your daughter of your upcoming surgery in 2 days. You have indicated you do not want to be a burden to her, but you also would like to have her here. You may have to decide rather quickly because of the time constraint.” The nurse is using the technique of: a. focusing. b. reflection. c. restatement. d. summarizing. ANS: D Summarizing presents the problem and possible solutions with the attendant difficulties. This technique “unclutters” the problem and presents it back to the patient for his or her choice of a solution. DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 36. The nurse is caring for a patient who states, “I tossed and turned last night.” The nurse responds to the patient, “You feel like you were awake all night?” This is an example of: a. open-ended question. b. restatement. c. reflection. d. offering self. ANS: B Restatement is a therapeutic communication technique in which the nurse restates in different words what the patient said. This encourages further communication on that topic. DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: Theory #3 TOP: Restatement KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 37. The nurse is caring for a patient who has just had a mastectomy (breast removal). The patient expresses concern that her husband will no longer find her attractive because of her mastectomy. The nurse appropriately responds: a. “You’re concerned your husband will find you unattractive because of your mastectomy?” b. “You’re a beautiful woman; of course your husband will find you attractive after your mastectomy.” c. “Don’t worry; when I had my mastectomy, my husband still found me very attractive.” d. “You should leave your husband immediately if he thinks you’re unattractive after a mastectomy.” ANS: A This is an example of restatement, which allows the patient to know her message was understood and encourages the patient to continue about her concerns on the topic. DIF: Cognitive Level: Application REF: p. 105 OBJ: Theory #3 TOP: Restatement/Reflection KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 38. A patient states, “I’m so worried that I might have cancer.” The nurse responds, “It is time for you to eat breakfast.” The nurse’s response is an example of: a. using clichés. b. judgmental response. c. changing the subject. d. giving false reassurance. ANS: C Changing the subject is a block to effective communication in which the patient is deprived of the chance to verbalize concerns. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 109|Table 8-3 Theory #3 TOP: Changing the Subject Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 39. The nurse is aware that the use of false reassurance is harmful to the nurse-patient relationship, because this communication block: a. discounts the patient’s stated concerns. b. shows a judgmental attitude on the part of the nurse. c. summarizes the patient’s concerns and closes communication. d. confuses the patient by giving information. ANS: A Giving false reassurance is a block to effective communication in which the patient’s feelings are negated and in which the patient may be given false hope, which, if things turn out differently, can destroy trust in the nurse. DIF: Cognitive Level: Comprehension REF: p. 109|Table 8-3 OBJ: Theory #3 TOP: False Reassurance KEY: Nursing Process Step: Implementation 40. A home health patient with a bleeding ulcer informs the nurse that she ate a bowl of chili with jalapenos. An inappropriate communication block with a judgmental tone by the nurse would be: a. “Well, you have had this problem long enough to know what will happen—you certainly can’t blame me!” b. “I don’t think that was a smart thing for you to do considering your ulcer.” c. “Well, you better watch your stool for evidence of blood so you can notify your primary care provider.” d. “Oh, poo! A bowl of chili every now and then won’t make a lot of difference to your ulcer.” ANS: B Judgmental response is a block to effective communication in which the nurse is judging the patient’s action. It implies that the patient must take on the nurse’s values and is demeaning to the patient. DIF: OBJ: KEY: MSC: Cognitive Level: Analysis REF: p. 109|Table 8-3 Theory #3 TOP: Judgmental Response Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 41. A patient tells the nurse that she dislikes the food that is served in the hospital. The nurse responds, “Our cooks work very hard; the food that is served is very good.” The nurse’s response is an example of the communication block of: a. judgmental response. b. giving advice. c. defensive response. d. using clichés. ANS: C Defensive response is a block to effective communication in which the nurse responds by defending the hospital food. This prevents the patient from feeling that she is free to express her feelings. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 109|Table 8-3 Theory #3 TOP: Defensive Response Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 42. A nurse caring for a patient who fell off the roof while he was intoxicated asks the patient, “Why in the world were you on the roof when you had been drinking?” The nurse’s statement is an example of which type of communication? a. Changing the subject b. Defensive response c. Inattentive listening d. Asking probing questions ANS: D Asking probing questions is a block to effective communication in which the nurse pries into the patient’s motives and therefore invades privacy. DIF: Cognitive Level: Comprehension REF: p. 109|Table 8-3 OBJ: Theory #3 TOP: Probing KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 43. The nurse caring for a patient who is concerned about her 10-pound weight loss relative to her chemotherapy tells the patient, “Lucky you! Every cloud has a silver lining.” The nurse’s statement is an example of which type of communication block? a. Defensive response b. Asking probing questions c. Using clichés d. Changing the subject ANS: C Using clichés is a block to effective communication in which the patient’s individual situation is negated, and the patient is stereotyped. This type of response sounds flippant and prevents the building of trust between the patient and the nurse. DIF: Cognitive Level: Comprehension REF: p. 109 OBJ: Theory #3 TOP: Clichés KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 44. The nurse is caring for a patient with a diagnosis of lung cancer. The nurse states, “If I were you, I would have radiation therapy.” The nurse’s statement is an example of which type of communication block? a. Inattentive listening b. Giving advice c. Using clichés d. Defensive response ANS: B Giving advice is a block to effective communication and tends to be controlling and diminishes patients’ responsibility for taking charge of their own health. DIF: Cognitive Level: Comprehension REF: p. 109 OBJ: Theory #3 TOP: Giving Advice KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 45. The nurse is caring for a patient who is concerned about living alone. The best response by the nurse is: a. “Where have you considered living?” b. “Why don’t you live with your family?” c. “I think you should live with your family.” d. “If you were my mom, I’d have you live with me.” ANS: A Rephrasing will help the patient explore various alternatives. The nurse should not use phrases such as “Why don’t you ...” “When that happened to me, I did ...” or “I think you should ...” Rephrasing, for example, “Have you thought of your options?” or “You might want to think about ...” or “Have you considered ...?” will help the patient explore various alternatives. DIF: Cognitive Level: Application REF: p. 104 OBJ: Theory #3 TOP: Offering Alternatives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 46. The characteristic that is representative of the nurse-patient relationship is that this relationship: a. focuses on the nurse’s ability to build rapport. b. continues after discharge. c. does not include humor. d. focuses on the assessed patient health problems. ANS: D The nurse-patient relationship focuses on the patient, has goals, and is defined by specific boundaries. The relationship takes place in the health care setting, and boundaries are defined by the patient’s problems, the help needed, and the nurse’s professional role. When the patient is discharged, the relationship ends. DIF: Cognitive Level: Knowledge TOP: Nurse-Patient Relationship MSC: NCLEX: N/A REF: p. 111 OBJ: Theory #4 KEY: Nursing Process Step: N/A 47. When communicating with an aphasic patient, the nurse appropriately: a. speaks quickly and shouts so the patient can hear. b. assumes the patient can understand what is heard. c. speaks to the patient’s caregiver about the patient. d. assumes the patient cannot understand what is heard. ANS: B When communicating with an aphasic patient, the nurse assumes the patient can understand what is heard even though speech is jargon or the person is mute, unless deafness has been diagnosed. The nurse should talk to the patient, and not talk to someone else in the room about the patient. The nurse should speak slowly and distinctly and should not shout. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 113|Box 8-1 Clinical Practice #3 TOP: Impaired Communication Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 48. When communicating with a hearing impaired patient, the nurse appropriately: a. shouts repeatedly at the patient. b. speaks directly into the patient’s ear. c. uses long, complex sentences. d. uses short, simple sentences. ANS: D When communicating with a hearing impaired patient, the nurse appropriately uses short, simple sentences. The nurse should not shout because this can distort speech and does not make the message any clearer. The nurse should never speak directly into the person’s ear. This can distort the message and hide all visual cues. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 113|Box 8-1 Clinical Practice #3 TOP: Impaired Communication Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 49. When communicating with a preschooler, the nurse should: a. use abstract explanations. b. use unfamiliar language. c. use long, complex sentences. d. consider the developmental level, using familiar words. ANS: D When interacting with a toddler or a preschooler, the nurse should focus on the child’s needs and concerns. The nurse should also use simple, short sentences and concrete explanations with familiar words. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 114 Clinical Practice #3 TOP: Communication with Children Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 50. When communicating with an adolescent, the nurse should be very sensitive to avoid: a. asking embarrassing questions. b. offering advice. c. interrupting frequently. d. using active listening. ANS: C An adolescent needs time to talk. The nurse should use active listening, avoid interrupting, and show acceptance. The nurse should try not to give advice. DIF: OBJ: KEY: MSC: Cognitive Level: Comprehension REF: p. 114 Clinical Practice #3 TOP: Communication Nursing Process Step: Implementation NCLEX: Psychosocial Integrity: Coping and Adaptation 51. The primary care provider informs the student nurse that he would like to give a telephone order. The best response by the student is: a. document the telephone order on the primary care provider’s orders. b. ask another student to listen as a witness to the telephone order. c. tape record the primary care provider giving the order to the student nurse. d. ask the registered nurse to take the telephone order. ANS: D The student nurse should have an instructor or another registered nurse standing by to take the new orders from the primary care provider because students cannot legally take telephone orders. DIF: Cognitive Level: Application TOP: Telephone Orders MSC: NCLEX: N/A REF: p. 115 OBJ: Theory #6 KEY: Nursing Process Step: N/A 52. A nurse is delegating to a nursing assistant. The most appropriate form of this type of communication would be: a. “Let me know if Mr. Jones’ temperature is high.” b. “I need to know if Mr. Jones’ blood pressure is elevated.” c. “Come and get me if Mr. Jones has a high heart rate.” d. “If Mr. Jones’ heart rate is greater than 100, let me know.” ANS: D It is important to communicate well in order to assign tasks and delegate to others effectively. The nurse should give clear, concise messages that include the desired results. DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: Theory #7 TOP: Delegation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 53. In order to safeguard patient information when using a computer, the nurse should: a. only use the computer located in the nurse’s station. b. wait until the end of the shift and document all information at one time. c. use personal code words and abbreviations to disguise information. d. change the computer password frequently. ANS: D Computerized patient information requires extra vigilance by the nurse to safeguard confidentiality. Changing personal passwords frequently helps safeguard information. When using the computer at a health care facility, the nurse must remember not to leave a computer screen open when he or she is finished. The nurse should always log out so that someone else cannot access information using his or her password and must not share his or her password with others. Computers in the nurse’s station are not as convenient as those at the bedside or in the hall. Personal codes and abbreviations are not useful. DIF: Cognitive Level: Comprehension TOP: Patient Information Safety MSC: NCLEX: N/A REF: p. 117 OBJ: Theory #8 KEY: Nursing Process Step: N/A MULTIPLE RESPONSE 1. The nurse is alert to avoid using blocks to effective communication that include: (Select all that apply.) a. changing the subject. b. using nonjudgmental remarks. c. giving advice. d. asking probing questions. e. offering hope. f. using clichés. ANS: A, C, D, F Such behavior as changing the subject, giving advice, asking probing questions that probe into a patient’s motive, and using clichés all block communication. Offering hope and giving remarks that are nonjudgmental are appropriate forms of communication. DIF: Cognitive Level: Comprehension REF: p. 107 OBJ: Theory #3 TOP: Effective Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation