Chapter 8: Communication and the Nurse-Patient Relationship Elsevier items and derived items 2009 by Elsevier Inc.

. MULTIPLE CHOICE 1. The nurse can best ensure that communication is understood by 1. speaking slowly and clearly in the patients native language. 2. asking the family members whether the patient understands. 3. obtaining feedback from the patient that indicates accurate comprehension. 4. checking for signs of hearing loss or aphasia before communicating. ANS: 3 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: Analysis REF: Page 106 TOP: Feedback KEY: Nursing Process Step: Evaluation OBJ: Theory #2 MSC: NCLEX: N/A

2. The nurse would recognize a verbal response in which of the following situations? 1. The patient nods her head up and down when asked whether she wants juice. 2. The patient writes the answer to a question asked by the nurse. 3. The patient begins sobbing uncontrollably when asked about her daughter. 4. The patient is moaning and restless and appears to be in pain. ANS: 2 Verbal communication involves words, either written or spoken. Nodding, sobbing, and moaning are nonverbal communication. DIF: Cognitive Level: Knowledge TOP: Verbal Communication Feedback MSC: NCLEX: N/A REF: Page 104 OBJ: Theory #1 KEY: Nursing Process Step: N/A

3. The patient who is consistent between her verbal and nonverbal communication is one who 1. smiles and laughs while speaking of feeling lonely and depressed. 2. wrings her hands and paces around the room while denying that she is upset. 3. is tearful and slow in speech when talking about her husbands death. 4. states she is comfortable while she frowns and her teeth are clenched. ANS: 3 Congruent communication is the agreement of verbal and nonverbal messages. DIF: Cognitive Level: Knowledge REF: Page 104 OBJ: Theory #1 TOP: Congruence KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A 4. A patient, who is Hispanic, approaches the nurse, who is Asian, and stands 12 inches away. 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 1. the nurses need to maintain a professional role rather than a social role.

2. a patient who is attracted to the nurse and is making sexual advances. 3. a nurses need to establish an intimate conversation space. 4. a difference in culturally learned personal space of the nurse and the patient. ANS: 4 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. A nurses professional role involves touch and close physical contact at times. There is nothing in the stem to indicate sexual contact or innuendo. Intimate space would be indicated by the nurse moving closer, not by backing away. DIF: Cognitive Level: Comprehension TOP: Cultural Differences MSC: NCLEX: N/A REF: Page 105 OBJ: Theory #2 KEY: Nursing Process Step: N/A

5. A nurse says to a patient, I am going to take your TPR, and then Ill check to see whether you can have a PRN dose of your analgesic. In considering factors that affect communication, the nurse has 1. used terminology to clearly inform the patient of what she is doing. 2. given information that is unnecessary for the patient to know. 3. used medical jargon, which might not be understood by the patient. 4. taken into consideration the patients need to know what is happening. ANS: 3 Medical jargon such as abbreviations or medical terminology is often not understood, even by well-educated people. DIF: Cognitive Level: Comprehension TOP: Blocks to Communication MSC: NCLEX: N/A REF: Page 105 OBJ: Theory #3 KEY: Nursing Process Step: N/A

6. A nurse who uses active listening 1. uses nonverbal cues such as leaning forward, focusing on the speakers face without staring, and slightly nodding to indicate that the message has been heard. 2. avoids the use of eye contact to allow the patient to express herself without feeling stared at or demeaned. 3. anticipates what the speaker is trying to say and helps the patient express herself when she has difficulty with finishing a sentence. 4. asks probing questions to direct the conversation and obtain the information needed as efficiently as possible. ANS: 1 Eye contact is a culturally learned behavior and in some cases may not be appropriate. Probing questions or finishing the patients sentence is not part of active listening and is detrimental to an interview. DIF: Cognitive Level: Application TOP: Active Listening MSC: NCLEX: N/A REF: Page 106 OBJ: Theory #3 KEY: Nursing Process Step: Implementation

7. If a patient says, I dont want to go home, the nurses best therapeutic verbal response is 1. Im sure everything will be fine once you get home. 2. You dont want to go home? 3. Doesnt your family want you to come home? 4. I felt like that when I had surgery last year. ANS: 2 The use of reflecting encourages the patient to expand on her feelings or thoughts. Items 1, 3, and 4 block therapeutic communication with false reassurance, prying or probing questions, and changing the subject (puts focus on nurses experience). DIF: Cognitive Level: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 8. To begin talking with a newly admitted patient about pain management, the nurse would most appropriately state 1. You look pretty comfortable. Are you having any pain? 2. Tell me about the pain youve been having. 3. Is this pain the same as the pain you had yesterday? 4. Dont worry; this pain wont last forever. ANS: 2 An open-ended question allows the patient to express her feelings or needs. Item 1 may prevent the patient from expressing how she feels, because the nurse has indicated she looks comfortable. Item 2 will not give the nurse any useful information about the pain. Item 4 is a clich and false reassurance. DIF: Cognitive Level: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 9. When a patient begins crying during a conversation with the nurse about the patients upcoming surgery for possible malignancy, the nurse can best respond with 1. Your surgeon is excellent, and I know hell do a great job. 2. changing the subject and getting the patient ready for bed. 3. Dont cry; think about something else and youll feel better. 4. offering the patient a tissue and sitting quietly nearby. ANS: 4 Offering self, or presence, and accepting a patients need to cry is supportive. Item 1 offers false reassurance; items 2 and 3 block any therapeutic communication with the implicit (explicit) message that it is not okay to cry or talk about feelings. DIF: Cognitive Level: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Therapeutic Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 10. To establish rapport with a patient, the nurse should

1. 2. 3. 4.

identify himself by name and title each time he introduces himself. share his own personal experiences so that the patient gets to know him as a friend. act in a trustworthy and reliable manner; respect the individuality of the patient. share information with the patient about other patients and why they are hospitalized.

ANS: 3 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: Cognitive Level: Comprehension REF: Page 111 OBJ: Clinical Practice #2 TOP: Rapport KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

11. A nurse who develops a therapeutic nurse-patient relationship will find that it differs from a social relationship, because 1. a social relationship does not have goals or needs to be met. 2. the nurse-patient relationship ends when the patient is discharged. 3. the focus is mainly on the nurse in the nurse-patient relationship. 4. a social relationship does not require trust or sharing of life experiences. ANS: 2 The nurse-patient relationship is time limited to the patients 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: Analysis TOP: Relationships MSC: NCLEX: N/A REF: Page 111 OBJ: Theory #4 KEY: Nursing Process Step: N/A

12. When using the telephone to communicate with a physician, the student nurse should 1. have an instructor or other registered nurse available to take any new orders. 2. tape-record the conversation to document the physicians orders. 3. require the physician to come to the facility in person to write new orders. 4. have another student listen to the conversation to document any new orders. ANS: 1 Students are not licensed and therefore cannot legally take the physicians telephone order. An RN may take a verbal order so that the physician does not have to come to the agency (although he must countersign the order within a specified period of time). DIF: Cognitive Level: Knowledge TOP: Telephone Communication MSC: NCLEX: N/A REF: Page 115 OBJ: Theory #6 KEY: Nursing Process Step: N/A

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. An end-of-shift report that best conveys part of the information needed by the nurse is which of the following? 1. Doing great, was up in the chair most of the day. No complaints of pain or discomfort. Voiding adequately. 2. Abdominal surgery yesterday, dressing is dry and intact, her IVs are on time and shes had pain meds twice. Vital signs stable. 3. Abdominal dressing dry, IVs800 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. Shes comfortable now. Vital signs are stable, no fever. 4. 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: 3 Although none of these answers is a complete shift report, item 3 is most specific in many of the aspects that would be included in such a report. DIF: Cognitive Level: Application REF: Page 115 OBJ: Clinical Practice #4 TOP: Shift Report KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 14. An aspect of computer use in patient care in which the LPN may need to be proficient includes 1. input of data such as vital signs, physical assessment, and medication administration. 2. programming the computer to record data from physicians and other health care workers. 3. teaching patients how to use hospital computers to record their own vital signs and medication administration. 4. scheduling admissions, discharges, and nurse staffing to keep the unit at the best occupancy and utilization. ANS: 1 Many facilities use computers for data entry. Programming such computers is not a nursing task, and patients do not take their own vital signs, nor are they legally responsible for the documentation of their care. Item 4 may be performed by a nurse/administrator but is not a role of the LPN. DIF: Cognitive Level: Knowledge TOP: Computer Use MSC: NCLEX: N/A REF: Page 116 OBJ: Theory #8 KEY: Nursing Process Step: N/A

15. A patient with a nursing diagnosis of Sensory perception, disturbed auditory would most appropriately require which of the following nursing interventions? 1. Obtain an interpreter when a family member is unavailable. 2. Speak slowly and distinctly, but do not shout. 3. Provide bright lighting without glare and orient frequently. 4. Reorient frequently to time, place, staff, and events.

ANS: 2 A patient with disturbed auditory perception cannot hear well (or at all); therefore, speaking slowly and distinctly, not shouting, increases patient comprehension. An interpreter is necessary only if a foreign language is spoken (or if sign language is used by the patient). Item 3 is used for a patient with visual alterations; item 4 is used for the confused or disoriented person. DIF: OBJ: TOP: KEY: Cognitive Level: Application REF: Page 113 Clinical Practice #3 Hearing-Impaired Patient Communication Nursing Process Step: Implementation

MSC: NCLEX: N/A

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 1. insulting the patients intelligence and memory. 2. acting in a cautious way to avoid charges of negligence. 3. verifying that the patient understands the information. 4. saving the extra time it would take to mail the information. ANS: 3 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 TOP: Telephonic Communication MSC: NCLEX: N/A REF: Page 106 OBJ: Theory #3 KEY: Nursing Process Step: Implementation

17. A 36-year-old woman is admitted to the hospital after an auto accident and is in traction for a fractured femur. The nurse enters the room and finds the patient crying quietly. The nurse can best address this situation by saying 1. Whats the matter? Why are you crying? Are you in pain? 2. Stop crying and tell me what your problem is. 3. This could have been much worse. Youre lucky no one was killed. 4. You are upset. Can you tell me whats wrong? ANS: 4 Item 4 provides the patient with an observation the nurse has made and a general lead to talk about what is wrong. Item 1 is probing and anxiety provoking; it questions without waiting for an answer. Item 2 indicates disapproval (stop crying) and item 3 includes clichs and disapproval. DIF: OBJ: KEY: MSC: Cognitive Level: Application REF: Page 107; Table 8-1 Theory #3 TOP: Reflecting Observations Nursing Process Step: Implementation NCLEX: Psychosocial Integrity

18. The nurse is giving direction to a nursing assistant to whom he is delegating part of the patient care. Which of the following gives the assistant the best direction?

1. Do the morning care first on the patients in 205 and 206 who cant get out of bed. 2. You take care of all the patients in 205 and 206. Let me know how youre doing and whether you need any help. 3. Give the patient in 204A a shower after breakfast, and call me to check her feet before you get her dressed. 4. Take the vital signs on all the patients in the lounge and tell me whether there are problems. ANS: 3 Item 3 is specific and leaves no room for misunderstanding. In item 1, the aide would have to find out who could not get out of bed. Item 2 is very vague, and item 4 does not indicate who the patients are in the lounge or what would constitute a problem. DIF: Cognitive Level: Analysis REF: Page 116 OBJ: Theory #7 TOP: Delegation KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment 19. A nurse who demonstrates empathy in his communication is likely to say 1. I feel the same way you do. I know just what youre going through. 2. It sounds like youre having a tough time dealing with this situation. 3. Its always darkest before the dawn. Hang in there; it will get better. 4. You sound pretty sorry for yourself. Why dont you look at the positives? ANS: 2 Empathy recognizes a patients situation and encourages expression of feelings. Item 1 is to be avoided, because it is usually impossible to really know how someone else feels, and it belittles the patients feelings and blocks expression. Item 3 is a clich (a block), and item 4 is disapproval and advice, which blocks communication. DIF: Cognitive Level: Application REF: Page 112 OBJ: Theory #3 TOP: Empathy KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 20. A patient asks the nurse, What would you do? The reply that can best help the patient is 1. If I were you, I would... 2. What solutions have you considered? 3. I would talk it over with my friends first. 4. I dont know. Im glad it isnt my decision. ANS: 2 Nurses 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: Cognitive Level: Analysis TOP: Communication Blocks MSC: NCLEX: N/A REF: Page 109 OBJ: Theory #3 KEY: Nursing Process Step: Implementation

21. The use of touch in the nurse-patient relationship

1. 2. 3. 4.

can convey caring and support when words are difficult. should be avoided because of problems of cultural misinterpretation. is appropriate only in special circumstances, such as with young children. is a nursing intervention of choice in almost all situations.

ANS: 1 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 patients situation and cultural values should determine its use, but it should not be avoided because of stereotypes. DIF: Cognitive Level: Comprehension TOP: Caring Touch MSC: NCLEX: N/A REF: Page 108 OBJ: Theory #4 KEY: Nursing Process Step: N/A

22. The statement, We can come back to that later...right now I need to know... is used to 1. let the patient know that what she was speaking about was inappropriate. 2. stop the patient from speaking about what she wants to speak about. 3. refocus the patient to the issue at hand when the focus has wandered. 4. close the conversation by quickly getting to the point of the conversation. ANS: 3 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: Application TOP: Refocusing Communication MSC: NCLEX: N/A REF: Page 106 OBJ: Theory #3 KEY: Nursing Process Step: Implementation

23. A patient who has had a stroke is unable to speak clearly or move the right side of her body. During the admission interview, the nurse correctly 1. asks questions and explains procedures to the patients daughter, who is present. 2. speaks slowly and gives the patient time to respond. 3. tells the patient he will get all necessary information from her daughter. 4. tells the patient not to worry, that her speech and paralysis will clear up soon. ANS: 2 The nurse should speak to the patient, not other people in the room about the patient. Speaking slowly recognizes that the patient may process (if she is able) information more slowly. Some information can be obtained from the daughter, but the nurses assessment must include the patients neurologic ability and deficits to establish the nursing diagnoses. Item 4 is a clich and a false reassurance. DIF: Cognitive Level: Comprehension REF: Page 113; Box 8-1 OBJ: Clinical Practice #3 TOP: Impaired Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 24. When a nurse is conducting an assessment interview, time will be saved by 1. explaining the purpose of the interview. 2. excluding relatives and friends from the interaction.

3. telling the patient what data are already available. 4. asking closed questions to obtain essential information. ANS: 4 Closed questions have a definite place when the nurse wants to obtain specific essential data. The nurse should always explain the purpose of any interview. It is unnecessary to tell the patient what data the nurse has, because he will ask questions to get information that he does not have or that he wishes to verify. Excluding others from an assessment interview should be the patients choice; it may or may not save time, because relatives may have important information. DIF: Cognitive Level: Knowledge REF: Page 111 OBJ: Clinical Practice #1 TOP: Interview KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A 25. The characteristics of a nurse that best facilitate the nurse-patient relationship are 1. intelligence and motivation. 2. energy and enthusiasm. 3. perfectionism and attention to detail. 4. acceptance and a nonjudgmental attitude. ANS: 4 The ability to accept patients for who they are and for the choices they make is essential for a successful nurse-patient relationship. Without those two, intelligence, motivation, energy, enthusiasm, and attention to detail fall short. Perfectionism can be either a positive or a negative trait (most often negative), but it is not helpful in the nurse-patient relationship. DIF: Cognitive Level: Analysis TOP: Nurse-Patient Relationship MSC: NCLEX: N/A REF: Page 112 OBJ: Theory #4 KEY: Nursing Process Step: N/A

26. Which of the following would be considered verbal communication? 1. The patient nods when asked if she would like her blinds closed. 2. The patient appears anxious and is pacing the halls. 3. The nurse provides the patient with written discharge instructions. 4. The patient is grimacing and appears to be in pain. ANS: 3 Verbal communication consists of words either spoken or written. Nonverbal communication is conveyed without words by gesture, expression, body posture, intonation, and general appearance. DIF: Cognitive Level: Analysis TOP: Communication MSC: NCLEX: N/A REF: Page 104 OBJ: Theory #1 KEY: Nursing Process Step: Evaluation

27. Which of the following would be considered nonverbal communication? 1. The patient states she is experiencing acute pain. 2. The patient is grimacing and appears to be in pain. 3. The patient writes that she is experiencing acute pain.

4. The patient asks the nurse to bring her pain medication. ANS: 2 Nonverbal communication is conveyed without words by gesture, expression, body posture, intonation, and general appearance. Verbal communication consists of words either spoken or written. DIF: Cognitive Level: Analysis TOP: Communication MSC: NCLEX: N/A REF: Page 104 OBJ: Theory #1 KEY: Nursing Process Step: Evaluation

28. The nurse is actively listening to a patient. Which of the following is appropriate for the nurse to do when actively listening? 1. Maintain eye contact by staring at the patient. 2. Interrupt when the patient talks excessively. 3. Make a conscious effort to block out other sounds. 4. Maintain a closed body posture by folding his arms. ANS: 3 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. The active listener does not interrupt the speaker and waits for the full message before interpreting what is said. Nonverbal cues that indicate active listening are leaning forward, focusing on the speakers face, nodding slightly to indicate the message is being heard, and maintaining an open body posture. DIF: Cognitive Level: Analysis TOP: Communication MSC: NCLEX: N/A REF: Page 106 OBJ: Theory #1 KEY: Nursing Process Step: Evaluation

29. The nurse is actively listening to a patient. Which of the following is inappropriate for the nurse to do when actively listening? 1. Maintain an open body posture. 2. Nod slightly to indicate hearing the speaker. 3. Lean forward as the patient is speaking. 4. Maintain eye contact by staring at the patient. ANS: 4 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. The active listener does not interrupt the speaker and waits for the full message before interpreting what is said. Nonverbal cues that indicate active listening are leaning forward, focusing on the speakers face, nodding slightly to indicate the message is being heard, and maintaining an open body posture. DIF: Cognitive Level: Analysis TOP: Communication MSC: NCLEX: N/A REF: Page 106 OBJ: Theory #1 KEY: Nursing Process Step: Evaluation

30. When interacting with an elderly patient, the nurse would appropriately do which of the following? 1. Speak quickly in order to promote time management. 2. Ensure the patient's hearing aid is turned off. 3. Face the person so she can see the nurse's lips. 4. Keep the nurse's mouth covered in order to prevent infection. ANS: 3 When interacting with an elderly person, the nurse should try not to speak too quickly and allow more time for the person to process the message and formulate a response. He should face the person so that his lips can be seen and so that the person has the optimal chance of hearing what he says. Many elderly have some degree of hearing loss, so the nurse should be certain any hearing aid is in place and turned on before the interaction begins. DIF: Cognitive Level: Analysis TOP: Communication MSC: NCLEX: Implementation REF: Page 106 OBJ: Theory #1 KEY: Nursing Process Step: Evaluation

31. When interacting with an elderly patient, the nurse would inappropriately do which of the following? 1. Speak quickly in order to promote time management. 2. Allow more time for the person to process the message. 3. Face the person so she can see the nurses lips. 4. Be certain the hearing aid is in place and turned on. ANS: 1 When interacting with an elderly person, the nurse should try not to speak too quickly and allow more time for the person to process the message and formulate a response. He should face the person so that his lips can be seen and so that the person has the optimal chance of hearing what he says. Many elderly have some degree of hearing loss, so the nurse should be certain any hearing aid is in place and turned on before the interaction begins. DIF: Cognitive Level: Analysis TOP: Communication MSC: NCLEX: N/A REF: Page 106 OBJ: Theory #1 KEY: Nursing Process Step: Implementation

32. When a patient states, I dont feel like walking today, the nurses best verbal response 1. You have to walk today. 2. You dont want to walk today? 3. I dont feel like walking today either. 4. Why dont you want to walk today? ANS: 2 Reflection is a way to restate the message. The same words the patient has said are reflected back. The idea is simply reflected back to the speaker in a statement to encourage continued dialogue on the topic. DIF: Cognitive Level: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A

33. When a patient states, My son hasnt been to see me in months, the nurses best verbal response is 1. Dont worry; I'm sure your son will visit. 2. Your son hasn't been around much lately. 3. My son doesn't come to visit me either. 4. How terrible that he doesn't visit you. ANS: 2 Restating in different words what the patient said encourages further communication on that topic. DIF: Cognitive Level: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 34. An example of a nurse communicating with a patient using open-ended questions is: 1. Are you in pain? 2. Did you sleep well? 3. Did you have a good day? 4. Tell me about your day. ANS: 4 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: Cognitive Level: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 35. The nurse is caring for a patient who states, I don't know if I should have chemotherapy, radiation, or both. The nurse remains quiet. The nurse is practicing which of the following therapeutic communication techniques? 1. Focusing 2. Reflection 3. Silence 4. Summarizing ANS: 3 Silence is a therapeutic communication technique in which the nurse maintains silence, sitting attentively but quietly. This allows patients time to gather their thoughts and sort them out. DIF: Cognitive Level: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A

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. The nurse's response is an example of which therapeutic communication technique? 1. Silence 2. Restatement 3. Reflection 4. Offering self ANS: 2 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: Application REF: Page 107; Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 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 1. Youre concerned your husband will find you unattractive because of your mastectomy? 2. Youre a beautiful woman; of course your husband will find you attractive after your mastectomy. 3. Dont worry; when I had my mastectomy, my husband still found me very attractive. 4. You should leave your husband immediately if he thinks youre unattractive after a mastectomy. ANS: 1 Giving reassurance not based on fact is damaging because it discounts the patients concerns and destroys trust. Saying, Dont worry, when a patient has valid concerns indicates a lack of understanding. DIF: Cognitive Level: Application TOP: Communication Techniques MSC: NCLEX: N/A REF: Page 109 OBJ: Theory #3 KEY: Nursing Process Step: Implementation

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 nurses response is an example of which type of communication block? 1. Using clichs 2. Judgmental response 3. Changing the subject 4. Giving false reassurance ANS: 3 Changing the subject is a block to effective communication in which the patient is deprived of the chance to verbalize concerns. DIF: Cognitive Level: Application REF: Page 110; Table 8-2

OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

39. A patient states, Im so worried that I might have a brain tumor. The nurse responds, You dont need to worry. The nurses response is an example of which type of communication block? 1. Giving false reassurance 2. Judgmental response 3. Giving advice 4. Defensive response ANS: 1 Giving false reassurance is a block to effective communication in which the patients 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: Application REF: Page 110; Table 8-2 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 40. A patient with a diagnosis of type 2 diabetes mellitus informs the nurse that she ate two doughnuts. The nurse responds, I dont think that was a smart thing for you to do considering you are diabetic The nurse's response is an example of which type of communication block? 1. Defensive response 2. Judgmental response 3. Giving advice 4. Giving false reassurance ANS: 2 Judgmental response is a block to effective communication in which the nurse is judging the patients action. It implies that the patient must take on the nurses values and is demeaning to the patient. DIF: Cognitive Level: Application REF: Page 110; Table 8-2 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 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 nurses response is an example of which type of communication block? 1. Judgmental response 2. Giving advice 3. Defensive response 4. Using clichs ANS: 3 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: Cognitive Level: Application REF: Page 110; Table 8-2 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 42. A nurse is caring for a patient who was stabbed by an intoxicated neighbor. The nurse asks the patient, Why were you associating with this neighbor? The nurses statement is an example of which type of communication block? 1. Changing the subject 2. Defensive response 3. Inattentive listening 4. Asking probing questions ANS: 4 Asking probing questions is a block to effective communication in which the nurse pries into the patients motives and therefore invades privacy. DIF: Cognitive Level: Application REF: Page 110; Table 8-2 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 43. The nurse is caring for a patient who is experiencing acute appendicitis. The nurse tells the patient, Cheer up. Youre a tough cookie; you'll be home soon. The nurses statement is an example of which type of communication block? 1. Defensive response 2. Asking probing questions 3. Using clichs 4. Changing the subject ANS: 3 Using clichs is a block to effective communication in which the patients 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: Application REF: Page 110; Table 8-2 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 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 nurses statement is an example of which type of communication block? 1. Inattentive listening 2. Giving advice 3. Using clichs 4. Defensive response ANS: 2 Giving advice is a block to effective communication and tends to be controlling and diminishes patients responsibility for taking charge of her own health.

DIF: Cognitive Level: Application REF: Page 110; Table 8-2 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 45. The patient informs the nurse she is experiencing pain. While the patient is speaking, the nurse has his hand on the door to go out. The nurses action is an example of which type of communication block? 1. Judgmental response 2. Inattentive listening 3. Changing the subject 4. Using clichs ANS: 2 Inattentive listening is a block to effective communication and indicates that the patient is not important, that the nurse is bored, or that what is being said does not matter. DIF: Cognitive Level: Application REF: Page 110; Table 8-2 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 46. The nurse is caring for a patient who is concerned about living alone. The best response by the nurse is 1. Where have you considered living? 2. Why dont you live with your family? 3. I think you should live with your family. 4. If you were my mom, Id have you live with me. ANS: 1 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 will help the patient explore various alternatives; for example, Have you thought of your options? or You might want to think about..., or Have you considered...? DIF: Cognitive Level: Application TOP: Communication Techniques MSC: NCLEX: N/A REF: Page 110 OBJ: Theory #3 KEY: Process Step: Implementation

47. Which of the following is accurate about the nurse-patient relationship? 1. Focuses on the nurse 2. Does not end 3. Does not have goals 4. Focuses on the patient ANS: 4 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 patients problems, the help needed, and the nurse's professional role. When the patient is discharged, the relationship ends. DIF: Cognitive Level: Knowledge REF: Page 111 OBJ: Theory #4

TOP: Nurse-Patient Relationship MSC: NCLEX: N/A

KEY: Nursing Process Step: N/A

48. When communicating with an aphasic patient, the nurse appropriately 1. speaks quickly and shouts so the patient can hear. 2. assumes the patient can understand what is heard. 3. speaks to the patient's caregiver about the patient. 4. assumes the patient cannot understand what is heard. ANS: 2 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: Cognitive Level: Comprehension REF: Page 113; Box 8-1 OBJ: Clinical Practice #3 TOP: Impaired Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 49. When communicating with a hearing-impaired patient, the nurse appropriately 1. shouts repeatedly at the patient. 2. speaks directly into the patient's ear. 3. uses long, complex sentences. 4. uses short, simple sentences. ANS: 4 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: Cognitive Level: Comprehension REF: Page 113 OBJ: Clinical Practice #3 TOP: Impaired Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 50. When communicating with a preschooler, the nurse should 1. use abstract explanations. 2. use unfamiliar language. 3. use long, complex sentences. 4. focus on the child's needs and consider a toddlers developmental level using familiar words. ANS: 4 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: Cognitive Level: Comprehension REF: Page 114 OBJ: Clinical Practice #3 TOP: Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: N/

51. When communicating with an adolescent, the nurse should 1. ask embarrassing questions. 2. offer advice. 3. interrupt frequently. 4. use active listening. ANS: 4 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, and avoid embarrassing questions if at all possible. DIF: Cognitive Level: Comprehension REF: Page 114 OBJ: Clinical Practice #3 TOP: Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 52. A student nurse is communicating with a physician via telephone. The physician informs the student nurse that he would like to give a telephone order. The best response by the student is 1. document the telephone order on the physician's orders. 2. ask a nursing assistant to take the order. 3. tape-record the physician giving the order to the student nurse. 4. ask the registered nurse to take the telephone order. ANS: 4 The student nurse should have an instructor or another registered nurse standing by to take the new orders from the physician because students cannot legally take telephone orders. DIF: Cognitive Level: Analysis TOP: Telephone Orders MSC: NCLEX: N/A REF: Page 115 OBJ: Theory #6 KEY: Nursing Process Step: N/A

53. A nurse is delegating to a nursing assistant. The most appropriate form of communication is which of the following? 1. Let me know if Mr. Jones temperature is high. 2. I need to know if Mr. Jones blood pressure is elevated. 3. Come and get me if Mr. Jones has a high heart rate. 4. If Mr. Jones heart rate is greater than 100, let me know. ANS: 4 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: Analysis REF: Page 116 OBJ: Theory #7 TOP: Delegation KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 54. In order to safeguard patient information when using a computer, the nurse should 1. leave the computer screen open when he is done. 2. share his computer password with his co-workers.

3. never log out in order to avoid losing patient data. 4. not share his computer password with co-workers. ANS: 4 Computerized patient information requires extra vigilance by the nurse to safeguard confidentiality. When using the computer at a health care facility, he must remember not to leave a computer screen open when he is finished. He must always log out so that someone else cannot access information using his password, and must not share his password with others. DIF: Cognitive Level: Analysis TOP: Patient Information Safety MSC: NCLEX: N/A COMPLETION 55. Pain is often conveyed through nonverbal communication. Two other common, nonverbally expressed emotions are _________________ and ______________. ANS: anxiety, fear Nonverbal communication needs to be observed and addressed to enhance the therapeutic relationship. DIF: Cognitive Level: Knowledge TOP: Nonverbal Communication MSC: NCLEX: N/A REF: Page 104 OBJ: Theory #1 KEY: Nursing Process Step: Assessment REF: Page 116 OBJ: Theory #8 KEY: Nursing Process Step: N/A

56. To elicit more information from a patient, the nurse should ask questions that require more than a one-word answer. This type of question is called _______-_________. ANS: open, ended Open-ended questions provide more information than can be gathered from closed-ended questions. DIF: Cognitive Level: Knowledge TOP: Open-Ended Questions MSC: NCLEX: N/A REF: Page 108 OBJ: Theory #1 KEY: Nursing Process Step: N/A

57. As a(n) ____________ listener, the nurse demonstrates interest in the patient through concentrating, focusing energy, maintaining eye contact, leaning forward, and nodding slightly to indicate the message is being heard. ANS: active The skills used for active listening convey caring and enhance the therapeutic relationship. DIF: Cognitive Level: Comprehension REF: Page 106 OBJ: Theory #1

TOP: Active Listening MSC: NCLEX: N/A MULTIPLE RESPONSE

KEY: Nursing Process Step: Implementation

58. Which of the following are blocks to effective communication? (Select all that apply.) 1. Changing the subject 2. Unflinching eye contact 3. Giving advice 4. Probing questions 5. Offering hope 6. Clichs ANS: 1, 2, 6 Understanding blocks to effective communication assists the student nurse to avoid these techniques. DIF: Cognitive Level: Comprehension REF: Pages 109-111 OBJ: Theory #3 TOP: Effective Communication KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 59. During the initial interview of a patient, the nurse should do which of the following? (Select all that apply.) 1. Assess the language capabilities of the patient. 2. Use open-ended questions. 3. Limit the interview to approximately 30 minutes. 4. Assess comprehension abilities of the patient. 5. Allow the patient to be as comfortable as possible. 6. Obtain the patients medical history from the physician. ANS: 1, 3, 4, 5 During the initial assessment, the patient should be comfortable and the nurse should ask closed-ended questions to elicit specific information. The interview should last approximately 30 minutes, and the nurse needs to evaluate the language and comprehension skills of the patient to ensure effective communication. DIF: Cognitive Level: Application REF: Page 111 OBJ: Clinical Practice# 1 TOP: Interview Skills KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A