Which action would the nurse take when a patient offers a small handmade gift during the termination phase of the professional relationship?

A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?

Nội dung chính

• Which action would the nurse take in the working phase of the therapeutic relationship?
• What occurs during the working phase of the nurse
• When working with the nurse during the orientation phase of the relationship?
• Which of the following are responsibilities of the nurse in the working phase?

The termination phase
The orientation phase
The working phase
The introduction phase

The working phase

Explanation:

There are three phases of a helping relationship: the orientation phase, the working phase, and the termination phase. The introduction phase is not a valid phase, yet the nurse introduces oneself during the orientation phase. The scenario defines characteristics of the working phase, during which the nurse and client work together to meet the client's physical and psychosocial needs. During the orientation phase, the nurse and client establish the tone and guidelines for the relationship . The termination phase occurs when the nurse and client acknolwedge that they have met the goals of the the initial agreement or that the client would be better served by another nurse or health care provider.

In which situation would the SBAR technique of communication be most appropriate?

A nurse is facilitating a family meeting to coordinate a client's discharge planning.
A nurse is explaining the process of bone marrow biopsy to a client who is scheduled for the procedure.
A nurse is calling a physician to report a client's new onset of chest pain.
A nurse is teaching a client about the benefits of smoking cessation and the risks of continuing to smoke.

A nurse is calling a physician to report a client's new onset of chest pain.

Explanation:
The SBAR technique of communication has numerous applications, including nurse-physician communication surrounding acute client developments. The technique is not normally applied in client education or in communication between the health care team and patients' families.

A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?

closed question
reflective question
validating question
open-ended question

open-ended question

Explanation:
The nurse's question allows for a wide range of responses and encourages free verbalization, characteristics of a useful open-ended question. Validating questions allow the nurse to confirm what was previously said, while closed questions necessitate a "yes" or "no" answer. A reflective question or comment repeats what the client has recently said.

Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached?

Commiseration
Sympathy
Kindness
Empathy

Empathy

Explanation:
Empathy refers to intuitive awareness of what the client is experiencing. It helps the nurse perform activities and remain emotionally neutral. Sympathy means feeling as emotionally distraught as the client. If the nurse sympathizes with the client, the nurse may feel equally disturbed, and performance may be affected. Kindness and commiseration also have an emotional component attached to them.

A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique?

Seeking clarification
Encouraging elaboration
Giving false reassurance
Giving information

Giving false reassurance

Explanation:
False reassurance means giving reassurance that is not based on the real situation. It is an attempt to alleviate the client's concerns about a situation by confidently saying that everything will be fine when, in fact, the nurse has no grounds for making such a statement. It minimizes the client's feelings and could cause the client to have false hope, be disillusioned when difficulties arise, and ultimately lose trust in the nurse. Seeking clarification means asking follow-up questions or making follow-up statements to clarify or gain more specific information about something the client has said. Giving information involves sharing accurate information about the client's health and well-being in a timely manner. Encouraging elaboration is a technique used to help the client describe more fully the concerns or problems being discussed.

A nurse enters the client's room and states, "Hello, Mr. Alonso. My name is Anthony Bader. I will be your registered nurse today. I will be providing your nursing care and will be with you until 3:30 PM. If you need anything, please call me on my phone or put your light on." The nurse then gives the client a printed card with this information. In the helping relationship, which phase does this represent?

Working phase
Orientation phase
Termination phase
Intimate phase

Orientation phase

Explanation:
The orientation phase consists of introductions and the establishment of an agreement between the nurse and the client about their mutual roles and responsibilities, as depicted in this scenario. The working phase consists of the nurse and client working together to meet the goals mutually established during the orientation phase, The termination phase consists of the nurse and client reviewing the client's progress toward the goals and concluding the relationship. There is no intimate phase in the helping relationship.

A nurse communicating with a client states, "I will be changing your dressing, but we have plenty of time to talk first." She is already wearing sterile gloves and a mask and is busy working with her back to the client. The nurse is conveying:

a congruent relationship.
an incongruent relationship.
a therapeutic relationship.
a functional focus.

an incongruent relationship.

Explanation:
What the nurse is communicating verbally and nonverbally are incongruent with each other. Even though the nurse is verbally saying that he or she has time to talk, the nurse's nonverbal actions demonstrate that he or she is ready to perform the procedure. In addition, the back turned to the client while speaking demonstrates closed communication.

A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client?

"The procedure may take only 2 minutes, so you might get through it by mentally counting up to 120."
"You may feel very uncomfortable when the needle goes in, but you should breathe rhythmically."
"I will be by your side throughout the procedure; the procedure will be painless if you don't move."
"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position."

"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position."

Explanation:
The nurse should provide correct knowledge as well as reassurance. Thoracentesis is a painful procedure and it is important for the client to sit still to avoid injuring the pleura. The nurse should reassure the client that the nurse will be present during the procedure and help the client throughout. Likewise, the nurse should avoid giving false reassurance by saying that the procedure will be painless. Additionally, the nurse should abstain from stating reasons that could scare the client.

A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation?

"Is today the first day of the month?"
"Is your name Evelyn?"
"Are you in a hospital?"
"What day of the week is it?"

"What day of the week is it?"

Explanation:
Asking the client to identify the day of the week represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking closed-ended questions, which are answered with a simple yes or no response. The remaining responses are all closed-ended questions and therefore would not provide an accurate assessment of the client's orientation.

A client has just been given a diagnosis of cirrhosis of the liver. Which statements by the nurse should be avoided because they could impede communication? Select all that apply.

"Cheer up. Tomorrow is another day."
"That's a lot of information to take in. Would you like to talk about it?"
"Everything will be all right."
"Your doctor knows best."
"Don't worry. You will be just fine in another day or two."

"Cheer up. Tomorrow is another day."
"Your doctor knows best."
"Don't worry. You will be just fine in another day or two."
"Everything will be all right."

Explanation:
A cliché is a stereotyped, trite, or pat answer. Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Clients tend to interpret them as a lack of real interest in what they have said. For example, even though the common question "How are you?" could start a conversation, it can cause a problem if the client hearing this suspects that the nurse is not sincerely interested in how he feels. Statements such as: "Everything will be all right," "Don't worry," and "Cheer up" impede communication and foster false hope. Stating your doctor knows best can lead to powerlessness in the client. On the other hand, acknowledging that the client has just received a lot of information and that it is understandable if the client is struggling to process it all is empathetic, and offering to talk about it opens up a line of communication rather than closing it.

A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:

swaddling the child and gently stroking its head.
staring into the neonate's eyes and smiling.
offering the neonate infant formula.
softly humming a song near the neonate.

swaddling the child and gently stroking its head.

Explanation:
Touch is the most highly developed sense at birth. Tactile experiences of infants and young children appear essential for the normal development of self and awareness of others. It has also been found that many older people long for touch, especially when isolated from loved ones because of hospitalization or long-term care facility care. Vision, taste, and hearing are not as fully developed as touch in the neonate.

A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication?

"Why are you treating me this way?"
"You always act like this."
"I think there is a better way to handle this."
"What is your problem with me?"

"I think there is a better way to handle this."

Explanation:
Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a non-defensive manner. "I" statements—"I feel . . ." and "I think . . ."—play an important role in assertive statements. They communicate personal feelings and preferences without expressing a judgment or blaming another person.

Which is an open-ended question?

"Why did the health care provider prescribe this medication for you?"
"When was the last time you had your prescription refilled?"
"How many tablets do you take at one time?"
"Do you take this medication daily?"

"Why did the health care provider prescribe this medication for you?"

Explanation:
Open-ended questions (e.g., "Why was this medication prescribed for you?") give the client an opportunity to express what the client understands and prevent the client from answering with just "yes" or "no" or some other one-word response. The other three responses require only a one-word response (e.g., "yes" or "no") and so are closed-ended questions.

Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse?

A nurse describes a client on Twitter by giving the client's diagnosis rather than the client's name.
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.
A nurse describes a client on Twitter by giving the room number rather than the name of the client.
A nurse posts pictures of a client who accomplished a goal of losing 100 lb and later deletes the photo.

A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.

Explanation:
A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse's and do not represent those of the employer. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly.

A nurse is engaged in a nurse-client relationship. Which communication techniques would be important for the nurse to avoid? Select all that apply.

Summarizing
Exploring
False reassurance
Silence
Giving advice

False reassurance
Giving advice

Explanation:
Nontherapeutic communication techniques include false reassurance and giving advice. Exploring, silence and summarizing are therapeutic techniques.

The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?
Encouraging elaboration
Reflection
Clarification
Restating

Encouraging elaboration

Explanation:
Encouraging elaboration involves making simple statements that indicate active listening and comprehension on the part of the nurse and that prompt the client to continue talking. This technique helps the client to describe more fully the concerns or problems under discussion. Clarification involves asking a follow-up question about a statement made by the client to clear up some point that the nurse is not sure about or to elicit more specific details. Reflection and restatement involve the nurse repeating back to the client a comment made by the client to ensure that the nurse has correctly heard or understood the client.

Mrs. Miller is a 60-year-old woman status post a hip replacement. She has had multiple complications following surgery including a skin infection and a blood clot. As a result, she has been a client on the unit for 6 weeks. The nurse has just returned from vacation and this is her first day caring for Mrs. Miller. A colleagues looks at the nurse and describes Mrs. Miller as "quite difficult to deal with." The nurse knows that all of the following can contribute to difficult behaviors except:

multiple family members in the room.
fatigue.
a quiet room.
language barrier.

a quiet room.

Explanation:
Language barrier, fatigue, and having too many family members are not conducive to good communication and can lead to what is perceived as difficult behaviors in a client. Taking time to reflect on one's own triggers, as well as environmental triggers, leads to reduction of difficulties.

Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?

positive regard
empathy
comfortable sense of self
analysis

analysis

Explanation:
Empathy, positive regard, and a comfortable sense of self were among the key ingredients. Empathy is an objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting yourself in another person's circumstances, and imagining what it would be like to share that person's feelings. Communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions or regard with the patient and family. Comfortable sense of self is part of the nursing confidence in caring for clients. Analysis is part of the nursing process and not the key elements of therapeutic communication.

A nurse administers pain medication to a client. Which action should the nurse take to facilitate trust?

Allow the client to vent about the pain.
Return in 30 minutes for follow-up per previous communication with the client.
Report pain medication administration to the nurse on the oncoming shift.
Share with the client a time the nurse was in pain.

Return in 30 minutes for follow-up per previous communication with the client.

Explanation:
When a nurse repeatedly upholds commitments made to a client, it fosters foundational trust within the therapeutic relationship, such as returning to see if the pain is receding. Empathy, including allowing the client to vent, may be part of the therapeutic relationship, but in this case the nurse's behavior will instill trust. Reporting to the oncoming nurse is important for the record, but the client may not be aware this is happening. Sharing a time the nurse was in pain can take the focus off the client and place it onto the nurse.

A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment?

Ask all visitors to leave the room.
Pull the curtain dividing the two beds.
Direct the client in the other bed to walk in the hallway.
Bring the client into the hallway to discuss the treatment plan.

Pull the curtain dividing the two beds.

Explanation:
It might not always be possible to carry on conversations alone with the client in a room, but every effort should be made to provide privacy and to prevent conversations from being overheard by others. Sometimes merely drawing the curtains around the bed in a hospital or long-term care facility, or sitting in a corner of the waiting room or lounge, can provide the sense of privacy that is so important in most interactions. It is not appropriate to ask the client in the other bed or any visitors to leave the room. Personal information should not be discussed in public thoroughfares.

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation?

Pity
Indifference
Empathy
Sympathy

Empathy

Explanation:
The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.

The nurse completes the admission process of a client to an acute care facility. Which statement by the nurse demonstrates the communication technique of focusing?

"You are frustrated because you are too tired to perform normal activities."
"You are unsure of what helps or prevents your fatigue."
"You have been having a great deal of fatigue for the last 3 months."
"You are hoping to figure out the cause of your extreme fatigue during this hospital stay."

"You are hoping to figure out the cause of your extreme fatigue during this hospital stay."

Explanation:
The statement "You are hoping to figure out the cause of your extreme fatigue during this hospital stay" focuses on the main problem that the client has been reporting and the goal for this admission. The other statements demonstrate the communication technique of clarifying.

A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because the nurse has not performed wound care on a complex wound in the past. Using effective intrapersonal communication, this nurse should:

ask the charge nurse to change the assignment.
inform the client that several nurses will be needed to care for this wound.
tell the unlicensed assistive personnel (UAP) to gather supplies and to prepare to cleanse and dress the wound.
tell oneself to "remain calm" and remember that the nurse was trained to perform this skill.

tell oneself to "remain calm" and remember that the nurse was trained to perform this skill.

Explanation:
Intrapersonal communication, or self-talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the client and family. Understanding the importance of intrapersonal communication can also help the nurse work with clients and families whose negative self-talk affects their health and self-care abilities. Speaking directly to the client, a UAP, or charge nurse is interpersonal communication, not intrapersonal. This duty cannot be delegated to an UAP. The nurse should not ask the charge nurse to change the assignment but could ask for help in dealing with the complex wound.

A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:

involve the child's stuffed animal in the educational session.
provide both verbal and written information to the child.
ask the child's parents to leave the room while the nurse and child talk.
show the child the intravenous catheter and explain how it works.

involve the child's stuffed animal in the educational session.

Explanation:
Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy. The use of music, art, and interior decorations might help put the client at ease. A client with newly diagnosed human immunodeficiency virus (HIV) infection will find it difficult to discuss sexual history or genital warts in an area that lacks privacy. A toddler might find it easier to communicate if a parent, favorite stuffed animal, or blanket is nearby. The parent should not be asked to leave the room and this may cause panic or anxiety in the child. A 3-year-old child will not be able to read written materials. Showing the child the catheter may frighten the child.

A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question?

"How old are your children?"
"Were these term births?"
"All right, you have four children, is that correct?"
"I understand you have four kids; how many times have you actually been pregnant?"

"I understand you have four kids; how many times have you actually been pregnant?"

Explanation:
The use of the clarifying question or comment allows the nurse to gain an understanding of a client's comment. In this scenario, the nurse is asking how many times the client has been pregnant. Gravida refers to the number of pregnancies, whereas para refers to the total number of live births. Confirming the client has four children is a form of validating what the client said. The age and/or term of the children does not clarify the original question asked by the nurse.

An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is afraid of waking up during surgery. The best response by the nurse is to:

state "everyone is afraid of that."
ask the surgeon to come to the bedside to reassure the client.
look directly at the client and state, "You are afraid of waking up during surgery."
ask why the client thinks the client will wake up during surgery.

ask why the client thinks the client will wake up during surgery.

Explanation:
Asking why the client thinks the client will wake up during surgery opens the lines of communication. Making a sweeping generalization that does not necessarily apply to a specific client hinders communication and makes the person feel insignificant. Restating the client's concern is inappropriate at this time. The nurse should not ask the surgeon to reassure the client. The nurse could ask the anesthesiologist to speak with the client to help alleviate any fears the client has.

A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response?

Nod and say, "I agree. If I were you, I would get a new doctor."
Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
Smile and say, "Don't worry, I am sure the physician is doing a good job."
Be silent and allow the client to continue speaking when ready.

Be silent and allow the client to continue speaking when ready.

Explanation:
When clients are angry or crying, the best nursing response is to remain nonjudgmental, allow them to express their emotions, and return later with a follow-up regarding their legitimate complaints. Therefore, staying silent and allowing the client to continue speaking when ready is the most appropriate response in this scenario. Giving false reassurance, agreeing, giving advice, or avoiding the subject are traps that block or hinder verbal communication.

A client, who was recently diagnosed with diabetes, has been coming to the emergency room every day for hyperglycemia. The client reports not being able to self-administer insulin injections. What strategy would best educate the client and improve the client's ability to self-administer insulin?

Refer to client to a diabetes educator and nutritionist.
Offer encouragement to boost the client's self-confidence.
Demonstrate the proper method and have the client mimic the demonstration.
Explain the importance of being able to control blood glucose levels with the injections.

Demonstrate the proper method and have the client mimic the demonstration.

Explanation:
The best strategy for this client is to demonstrate the proper administration and have the client mimic the demonstration to ensure the client is confident and knowledgeable on self-administration. Offering encouragement and explaining the importance of self-administration is important, but not the best method to ensure compliance. The client may or may not need to be referred to a nutritionist, and the nurse should be considered the diabetes educator.

A 35-year-old client with Down syndrome is on the nurse's unit following heart surgery. The client is very weak and has had difficulty with activities of daily living. Which statement is the best example of the nurse using advocacy as a style of client communication?

"I know that it has been difficult for you to walk to the bathroom to brush your teeth. How can we make this work for you?"
"If you do not get up and move around you may develop a blood clot. Wouldn't your family be so stressed if you had to stay in the hospital longer? Do you want to walk in the hall or in the courtyard?"
"I realize that eating makes you tired, but you need to eat to get healthy. Would you like to pick out your dinner menu?"
"You have to get out of bed; otherwise you may get a blood clot. Do you want to take a bath or shower?"

"I know that it has been difficult for you to walk to the bathroom to brush your teeth. How can we make this work for you?"

Explanation:
The nurse advocates for the client by offering the client choices based on the current situation. The other options are examples of guilt inducement and authoritarian interaction where the client is unable to make one's own decision about treatment options and nursing care. Either/or questions, such as taking a bath or shower and walk in hall or courtyard, are allowing the client to make one's own decision about care or treatment. Either/or questions are usually choices on how the care be done (bath or shower) or how the treatment will be completed (walking in the hall or courtyard); either way the care will be done or the treatment will be completed.

A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening?

"You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure."
"I understand your confused, what do you think you should do?"
"I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?"
"You seem unsure. Tell me your concerns about your surgery."

"You seem unsure. Tell me your concerns about your surgery."

Explanation:

The term metacommunication is best defined as:

congruent relationships in the spoken topics.
documenting a conversation between the client and nurse.
interpersonal bridge between verbal and nonverbal communication.
contextual factors that impede communication patterns.

interpersonal bridge between verbal and nonverbal communication.

Explanation:

Metacommunication is a communication about the client's communication or lack thereof. It is an implicit, but integral, part of the message and is an interpersonal bridge between the verbal and nonverbal components of communication.

The mother of a toddler is deciding if she wants to allow her child to receive the recommended immunizations. The clinic nurse responds, "If you don't immunize your child you are jeopardizing the health of other children." What type of approach does this response indicate?

guilt inducement or approval/disapproval
advocacy or enforcing rights
authoritarian or belittling
dictatorial or bossing

guilt inducement or approval/disapproval

Explanation:
This response by the nurse attempts to induce guilt on the parent to make what the nurse views as the best choice. Authoritarian responses dictate what the client should do based on the health care worker's professional opinion. An advocacy response supplies the client with information to make the decision.

A nurse visits a female victim of sexual assault. During the visit the client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse?

"In reality, the sexual assault did not occur yesterday; it has been over one month now."
"Tell me more about the aspects that make you feel as if it happened yesterday."
"We should move on from the strong feelings associated with this incident."
"Can you do something to alleviate the fear of being assaulted again?"

"Tell me more about the aspects that make you feel as if it happened yesterday."

Explanation:
The nurse should make statements that would facilitate an expression of feelings from the client. The nurse should encourage the client to express her fears and insecurity. This conveys that the nurse is there to provide support. This type of therapeutic approach happens during the working phase. The nurse should avoid giving an opinion and should in fact allow the client to hold on to the feelings. Making the client realize that the rape occurred a month ago would block communication.

A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation?

The client is sitting in a chair and states, "I feel a lot better than I did yesterday.
The client stares at the floor and states, "I feel fine."
The client smiles at the nurse and states, "I cannot wait to go home."
The client looks at the nurse and states, "I am still not feeling my best."

The client stares at the floor and states, "I feel fine."

Explanation:
It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, in the scenario in which the client stares at the floor while claiming to feel fine, the nurse should investigate further because of the incongruence between the client's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication is effective and no further investigation is warranted.

A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to:
have group members issue a written warning to the dominant member.

pick a team leader who is not the dominant member.
plan a meeting where the dominant person cannot attend.
have group members confront the dominant member to promote the needed team work.

have group members confront the dominant member to promote the needed team work.

Explanation:
Effective groups have members who are mutually respectful. If a group member dominates or thwarts the group process, then the leader or other group members must confront the member to promote the needed collegial relationship. Planning a secret meeting does not solve the underlying issue. Picking a team leader who is not the dominant member will not address the dominance issue. A written warning would be inappropriate; a verbal communication is what is required among the team.

A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should:

remain honest, open, and frank.
ask if the client realizes the infection is a direct result of the drug use.
consult with the social worker regarding inpatient drug rehabilitation.
ask the client for a urine specimen for urine drug use screening.

remain honest, open, and frank.

Explanation:
One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice. When a client feels that a nurse is being judgmental, the client might withhold significant information. The nurse needs to develop sensitivity to the unique challenges presented by each client. A urine drug screen may eventually be ordered but is not necessary at this time. There is no evidence the client wants drug rehabilitation at this time. There is no evidence that the skin infection is secondary to the drug use.

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply.

"Is there any chance you might be pregnant?"
"Does it hurt when I touch you here?"
"What sorts of things do you do for fun?"
"What plans do you have after you are discharged?"
"Do you smoke cigarettes?"
"Are you ready to get out of bed?"

"Are you ready to get out of bed?"
"Do you smoke cigarettes?"
"Is there any chance you might be pregnant?"
"Does it hurt when I touch you here?"

Explanation:
The closed-ended question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed-ended questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. Closed-ended questions are often a barrier to effective communication. Asking what the client does for fun or what the client's future plans are facilitates communication between the client and the nurse.

A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?

Working phase
Evaluation phase
Orientation phase
Termination phase

Orientation phase

Explanation:
During the orientation phase, the nurse discusses with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the nurse and client acknowledge that the agreement on which the relationship is based is concluding. There is no evaluation phase of the nurse-client relationship (evaluation is the final step in the nursing process).

A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse?

"You're worried about how you will tolerate the pain associated with labor."
"There are many good medications to decrease the pain; it will not be so bad."
"Don't worry about labor, I have been through it and it is not so bad."
"I would recommend keeping a positive attitude."

"You're worried about how you will tolerate the pain associated with labor."

Explanation:
Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives.

The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client?

Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive.
Approach the client with empathy and understanding and allow the client to share feelings without being judged.
Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation.
Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding.

Approach the client with empathy and understanding and allow the client to share feelings without being judged.

Explanation:
Rapport is a feeling of mutual trust between nurse and client. Kindness is the quality of being friendly, generous, and considerate. Active listening and the use of silence are communication techniques, but they do not necessarily develop mutual trust between the nurse and client.

The nurse makes a contract with the client during which phase of the nurse-client relationship?

Working phase
Orientation phase
Intimate phase
Termination phase

Orientation phase

Explanation:
The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase.

A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse?

"I am so sorry you are going through this. Can we talk?"
"Sitting in the dark is not going to cure your cancer. Let's open the curtains."
"Can you please tell me why you are crying?"
"I know this is hard for you. Is there any way I can help?"

"I know this is hard for you. Is there any way I can help?"

Explanation:
Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. By retaining this quality, you can establish successful helping relationships without appearing cold or stern. The statement "I am so sorry you are going through this" demonstrates sympathy. Sympathy differs from empathy because it shifts the emphasis from the client to the nurse as the nurse shares feelings and personal concerns and projects them onto the client, limiting the ability to focus objectively on the client's needs. Asking about why the client is crying is part of information gathering but is not empathy. Stating that sitting in the dark will not cure cancer is an abrasive statement that may work against the nurse-client relationship.

Which nursing actions would most likely help improve communication with clients and achieve a more effective helping relationship? Select all that apply.

The nurse controls the tone of voice so that it conveys exactly what is meant.
The nurse feels free to use words that might have different interpretations when using the same language as the client.
The nurse remains focused on the topic at hand and does not allow the client to diverge to another topic.
The nurse makes statements that are as simple as possible, gearing conversation to the client's level.
The nurse never admits a lack of knowledge to the client to avoid undermining the client's confidence in the helping relationship.
The nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations.

The nurse controls the tone of voice so that it conveys exactly what is meant.
The nurse makes statements that are as simple as possible, gearing conversation to the client's level.
The nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations.

Explanation:
The following nursing actions would most likely help improve communication with clients and achieve a more effective helping relationship: The nurse controls the tone of voice so that it conveys exactly what is meant; the nurse makes statements that are as simple as possible, gearing conversation to the client's level; the nurse takes advantage of any available opportunities to communicate information to clients in routine caregiving situations. The nurse attempts to remain focused on the topic at hand but must allow the client to diverge to another topic, as appropriate. The nurse must be careful not to use words that might have different interpretations than what the nurse meant. The nurse should admit a lack of knowledge to the client to avoid undermining the client's confidence in the helping relationship.

The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important?

Speak directly to the client.
Ensure that family members are present.
Give all of the discharge instructions at once.
Have the interpreter write out all of the information listed in the unit brochure.

Speak directly to the client.

Explanation:
When utilizing an interpreter, speak clearly in a conversational tone and directly address the client. While a client may be more comfortable having a family member present, this is not required. The nurse should not give all of the discharge instructions at once, which is likely to overwhelm the client, but provide discharge teaching in brief, manageable increments. Interpreters should not be asked to translate written information; instead, the nurse should verbally explain the brochure, or a copy should be obtained in the client's native language.

A nurse is conducting a health history. The client's spouse is answering the interview questions. What question would be appropriate to ask the client before proceeding with the remainder of the interview?

"Do you have a hearing impairment preventing you from hearing the questions?"
"Why is your spouse answering the questions?"
"Can you ask your spouse to leave the room?"
"Who manages health care-related issues in your family?"

"Who manages health care-related issues in your family?"

Explanation:
In some cultures, the male is considered the head of the family and makes health care decisions and takes the role of answering questions related to health and medical care. It is important to establish who makes those decisions and to be respectful of the client's culture. It is best to take cues from the client. A client that is allowing another family member to answer questions may be doing so based upon the culture and roles in the family; it is important to clarify. Asking the spouse to leave the room or asking why the spouse is answering the questions can be insensitive and unprofessional. While asking about a hearing impairment may be appropriate, determining who makes the decisions is priority.

A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be:

assertive.
nurturing.
aggressive.
passive.

aggressive.

Explanation:
Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication.

When collecting data on a client, the nurse implements which nonverbal communication form as one of the most effective to express feelings?

Body posture
Eye contact
Gait
Touch

Touch

Explanation:
Touch, despite its individual variability, is viewed as one of the most effective nonverbal communication methods to express feelings. Not all cultures use direct eye contact; it may be considered disrespectful. Posture and gait are used to express feelings, but they are not as effective as touch.

A nurse states the following to another nurse who is constantly forgetting to wash hands between clients: "It looks like you keep forgetting to wash your hands between clients. It's really not safe for your clients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech?

Assertive
Therapeutic
Nonassertive
Aggressive

Assertive

Explanation:
The communication is an example of assertive speech. Assertive communication is the ability to stand up for oneself and others using open, honest, and direct communication. Aggressive communication involves asserting one's rights in a negative manner that violates the rights of others. Therapeutic speech is speech a nurse uses when communicating with a client that has a specific purpose or goal. Nonassertive speech would be the opposite of assertive speech, as described above.

Which action would the nurse take in the working phase of the therapeutic relationship?

Which action by the nurse or client represents the working phase of the therapeutic relationship? In the working phase of the relationship, the client is involved actively in achieving goals set during the initial phase.

What occurs during the working phase of the nurse

The working phase of the nurse-client relationship involves active participation toward goals and genuine expression of concerns and feelings. Identification of goals and relationships occurs in the orientation phase.

When working with the nurse during the orientation phase of the relationship?

The orientation phase is the period when the nurse and patients first meet and goals are set. The goal of the orientation phase is to build trust and respect. Next comes the working phase, which is the period when solutions are explored, tried, and evaluated. The goal of the working phase is to promote change.

Which of the following are responsibilities of the nurse in the working phase?

Nurses responsibility in working Phase Gather more and more data of the patient to explore the stressors. Help the patient to promote coping mechanisms and develop insight. Let the patient understand his behavioral change by evaluating himself.

Which action would the nurse take when right before starting the IV?

What does the nurse observe the client to be in need of?

Which important points would the nurse keep in mind regarding EpiPen(EpiPen) prefilled syringes?

When considering the administration of an analgesic the nurse identifies?

Which action would the nurse perform during the working phase of a helping relationship in a hospital setting?

What is the nurse's role in the termination phase of the nurse

When a nurse feels like she is the only one who understands the patient what is that called?

What are the 5 stages of nurse patient relationship in order?