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ISBN-10: 0323242812

ISBN-13: 9780323242813

 

Test Bank of Interpersonal Relationships Professional Communication Skills For Nurses 7th Edition By Boggs Arnold

 

Chapter 1: Theory Based Perspectives and Contemporary Dynamics

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. When describing nursing to a group of nursing students, the nursing instructor lists all of the following characteristics of nursing except
a. historically nursing is as old as mankind.
b. nursing was originally practiced informally by religious orders dedicated to care of the sick.
c. nursing was later practiced in the home by female caregivers with no formal education.
d. nursing has always been identifiable as a distinct occupation.

 

 

ANS:  A

Historically, nursing is as old as mankind. Originally practiced informally by religious orders dedicated to care of the sick and later in the home by female caregivers with no formal education, nursing was not identifiable as a distinct occupation until the 1854 Crimean war. There, Florence Nightingale’s Notes on Nursing introduced the world to the functional roles of professional nursing and the need for formal education.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nursing profession’s first nurse researcher, who served as an early advocate for high-quality care and used statistical data to document the need for handwashing in preventing infection, was
a. Abraham Maslow.
b. Martha Rogers.
c. Hildegard Peplau.
d. Florence Nightingale.

 

 

ANS:  D

An early advocate for high-quality care, Florence Nightingale’s use of statistical data to document the need for handwashing in preventing infection marks her as the profession’s first nurse researcher.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 1

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Today, professional nursing education begins at the
a. undergraduate level.
b. graduate level.
c. advanced practice level.
d. administrative level.

 

 

ANS:  A

Today, professional nursing education begins at the undergraduate level, with a growing number of nurses choosing graduate studies to support differentiated practice roles and/or research opportunities. Nurses are prepared to function as advanced practice nurse practitioners, administrators, and educators.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 2

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Nursing’s metaparadigm, or worldview, distinguishes the nursing profession from other disciplines and emphasizes its unique functional characteristics. The four key concepts that form the foundation for all nursing theories are
a. caring, compassion, health promotion, and education.
b. respect, integrity, honesty, and advocacy.
c. person, environment, health, and nursing.
d. nursing, teaching, caring, and health promotion.

 

 

ANS:  C

Individual nursing theories represent different interpretations of the phenomenon of nursing, but central constructs—person, environment, health, and nursing—are found in all theories and models. They are referred to as nursing’s metaparadigm.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 2

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. When admitting a client to the medical-surgical unit, the nurse asks the client about cultural issues. The nurse is demonstrating use of the concept of
a. person.
b. environment.
c. health.
d. nursing.

 

 

ANS:  B

The concept of environment includes all cultural, developmental, and social determinants that influence a client’s health perceptions and behavior. A person is defined as the recipient of nursing care, having unique bio-psycho-social and spiritual dimensions. The word health derives from the word whole. Health is a multidimensional concept, having physical, psychological, sociocultural, developmental, and spiritual characteristics. The World Health Organization (WHO, 1946) defines health as “a state of complete physical, mental, social well-being, not merely the absence of disease or infirmity.” Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people.

 

DIF:    Cognitive Level: Application          REF:   p. 3

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A young mother tells the nurse, “I’m worried because my son needs a blood transfusion. I don’t know what to do, because blood transfusions cause AIDS.” Which central nursing construct is represented in this situation?
a. Environment
b. Caring
c. Health
d. Person

 

 

ANS:  D

The concept of environment includes all cultural, developmental, and social determinants that influence a client’s health perceptions and behavior. Caring is not one of the four central nursing constructs. The word health derives from the word whole. Health is a multidimensional concept, having physical, psychological, sociocultural, developmental, and spiritual characteristics. The World Health Organization (WHO, 1946) defines health as “a state of complete physical, mental, social well-being, not merely the absence of disease or infirmity.” Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Person is defined as the recipient of nursing care, having unique bio-psycho-social and spiritual dimensions.

 

DIF:    Cognitive Level: Application          REF:   p. 2

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse performs a dressing change using sterile technique. This is an example of which pattern of knowledge?
a. Empirical
b. Personal
c. Aesthetic
d. Ethical

 

 

ANS:  A

Empirical knowledge is the scientific rationale for skilled nursing interventions. Personal ways of knowing allow the nurse to understand and treat each individual as a unique person. Aesthetic ways of knowing allow the nurse to connect in different and more meaningful ways. Ethical ways of knowing refer to the moral aspects of nursing.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 5

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Management of Care

 

  1. The nurse-client relationship as described by Hildegard Peplau
a. would not be useful in a short-stay unit.
b. allows personal and social growth to occur only for the client.
c. facilitates the identification and accomplishment of therapeutic goals.
d. focuses on maintaining a personal relationship between the nurse and client.

 

 

ANS:  C

Hildegard Peplau offers the best-known nursing model for the study of interpersonal relationships in health care. Her model describes how the nurse-client relationship can facilitate the identification and accomplishment of therapeutic goals to enhance client and family well-being. In contemporary practice, Peplau’s framework is more applicable today in longer term relationships, and in settings such as rehabilitation centers, long-term care, and nursing homes. Despite the brevity of the alliances in acute care settings, basic principles of being a participant observer in the relationship, building rapport, developing a working partnership, and terminating a relationship remain relevant.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 10

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. The identification phase of the nurse-client relationship
a. sets the stage for the rest of the relationship.
b. correlates with the assessment phase of the nursing process.
c. focuses on therapeutic goals to enhance client and family well-being.
d. uses community resources to help resolve health care issues.

 

 

ANS:  C

Hildegard Peplau offers the best-known nursing model for the study of interpersonal relationships in health care. Her model describes how the nurse-client relationship can facilitate the identification and accomplishment of therapeutic goals to enhance client and family well-being.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 10

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Management of Care

 

  1. Abraham Maslow’s needs theory is a framework that
a. begins with meeting basic psychosocial needs first.
b. ensures essential needs are satisfied, then people move into higher physiological areas of development.
c. proposes that people are motivated to meet their needs in a descending order.
d. nurses use to prioritize client needs and develop relevant nursing approaches.

 

 

ANS:  D

Abraham Maslow’s needs theory is a framework that nurses use to prioritize client needs and develop relevant nursing approaches. Maslow’s model proposes that people are motivated to meet their needs in an ascending order beginning with meeting basic survival needs. As essential needs are satisfied, people move into higher psychosocial areas of development.

 

DIF:    Cognitive Level: Application          REF:   p. 10

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following statements about communication theory is true?
a. Primates are able to learn new languages to share ideas and feelings.
b. Concepts include only verbal communication.
c. Perceptions are clarified through feedback.
d. Past experience does not influence communication.

 

 

ANS:  C

Feedback is the only way to know that one’s perceptions about meanings are valid. Human communication is unique. Only human beings have large vocabularies and are capable of learning new languages as a means of sharing their ideas and feelings. Communication includes language, gestures, and symbols to convey intended meaning, exchange ideas and feelings, and to share significant life experience. To encode a message appropriately requires a clear understanding of the receiver’s mental frame of reference (e.g., feelings, personal agendas, past experiences) and knowledge of its purpose or intent of the communication.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 7

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. In the circular transactional model of communication,
a. questions are framed in order to recognize the context of the message.
b. people take only complementary roles in the communication.
c. the context of the communication is unimportant.
d. the purpose of communication is to influence the receiver.

 

 

ANS:  A

A circular model expands linear models to include the context of the communication, feedback loops, and validation. With this model, the sender and receiver construct a mental picture of the other, which influences the message and includes perceptions of the other person’s attitude and potential reaction to the message.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 8

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse recognizes that feedback loops
a. do not allow for correction of original information.
b. are solely based on the General Systems Theory.
c. do not allow for validation of information.
d. allow the human system to correct its original information.

 

 

ANS:  D

Feedback (from the receiver or the environment) allows the system to correct or maintain its original information. Feedback loops (from the receiver, or the environment) validate the information, or allow the human system to correct its original information. General Systems Theory, initially described by Ludwig von Bertalanffy (1968), focuses on process and interconnected relationships comprising the “whole.”

 

DIF:    Cognitive Level: Knowledge          REF:   p. 8

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following statements best represents therapeutic communication when a student discovers a client crying in bed?
a. “I am the nurse who will be doing your treatments today.”
b. “Will you listen to me so I can help you get better?”
c. “This is what is going to happen during surgery.”
d. “Can we talk about what seems to be bothering you?”

 

 

ANS:  D

Asking about what is bothering the client is goal directed. Its purpose is to promote client well-being. “I am the nurse who will be doing your treatments today” is a statement of fact, and it ignores the client’s emotional needs. “Will you listen to me so I can help you get better?” is not goal directed and does not involve mutuality. “This is what is going to happen during surgery” is simply one way. It does not engage the client in a therapeutic manner.

 

DIF:    Cognitive Level: Application          REF:   p. 10

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The central constructs of person, environment, health, and nursing are found in all nursing theories and models and are referred to as
a. telehealth.
b. the medical model.
c. nursing’s metaparadigm.
d. five core areas of competency.

 

 

ANS:  C

Individual nursing theories represent different interpretations of the phenomenon of nursing, but central constructs—person, environment, health, and nursing—are found in all theories and models. They are referred to as nursing’s metaparadigm. These constructs are the “metalanguage” of nursing, and together they act as basic building blocks for the discipline of professional nursing. Telehealth is fast becoming an integral part of the health care system, used both as a live interactive mechanism (particularly in remote areas, where there is a scarcity of health care providers) and as a way to track clinical data. Two important outcomes are reduced health costs and increased access to care. During the last century, the bulk of professional care was delivered in acute care settings, based on the disease-focused medical model. Switching to today’s community focus recognizes the fact that chronic medical conditions account for most of today’s care, with most being treated in the community. The IOM report Health professions education: A bridge to quality (2003) calls for the restructuring of clinical education responsive to the 21st century health system transformation goals of providing the highest quality and safest medical care possible. This report identified five core areas of competency required to cross the bridge to quality.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 4

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. The discipline of nursing has “a unique perspective, a distinct way of viewing all phenomena, which ultimately defines and limits the nature of its inquiry,” related to (Select all that apply.)
a. principles and laws that govern the life processes, well-being, and optimum functioning of human beings, sick or well.
b. patterning of human behavior in interaction with the environment in critical life situations.
c. processes by which positive changes in health status are affected.
d. processes by which negative changes in health status are affected.
e. patterning of human behavior in interaction with the environment in every life situation.
f. principles and laws that govern the life processes, well-being, and optimum functioning of human beings, in relation to wellness only.

 

 

ANS:  A, B, C

Donaldson and Crowley characterize the discipline of nursing as having “a unique perspective, a distinct way of viewing all phenomena, which ultimately defines and limits the nature of its inquiry,” related to “Principles and laws that govern the life processes, well-being, and optimum functioning of human beings, sick or well; patterning of human behavior in interaction with the environment in critical life situations; and processes by which positive changes in health status are affected.”

 

DIF:    Cognitive Level: Application          REF:   p. 2

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Health Promotion and Maintenance

 

Chapter 2: Professional Guides for Nursing Communication

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. The nurse demonstrates effective communication by ensuring all of the following except
a. two-way exchange of information among clients and health providers.
b. making sure that unilateral information is exchanged between clients and nurses.
c. making sure that the expectations and responsibilities of all are clearly understood.
d. recognizing that effective communication is an active process for all involved.

 

 

ANS:  B

Effective communication is defined as a two-way exchange of information among clients and health providers ensuring that the expectations and responsibilities of all are clearly understood. It is an active process for all involved.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 23

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A preoperative assessment shows that a client’s hemoglobin level is dropping. The anesthetist orders 3 units of blood to be administered. The nurse administers the first unit before discovering that the client is a Jehovah’s Witness, as documented in the record. This is an example of
a. professional conduct.
b. a negligent act.
c. physical abuse.
d. breaching client confidentiality.

 

 

ANS:  B

The nurse was negligent by not checking the record and by failure to obtain written consent from the client for the procedure. This is an example of misconduct, not professional conduct. The nurse did not intend to physically harm the patient. The nurse did not breach client confidentiality.

 

DIF:    Cognitive Level: Application          REF:   pp. 28-29

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following is a violation of client confidentiality? Reporting
a. certain communicable diseases.
b. child abuse.
c. gunshot wounds.
d. client data to a colleague in a nonprofessional setting.

 

 

ANS:  D

Releasing information to people not directly involved in the client’s care is a breach of confidentiality. Certain communicable or sexually transmitted diseases, child and elder abuse, and the potential for serious harm to another individual are considered exceptions to sharing of confidential information.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 37

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A 16-year-old trauma victim arrives in the emergency department with a life-threatening condition and requires emergency surgery. The nurse knows that
a. a parent/guardian must give consent.
b. the client can give consent if she provides proof of emancipation.
c. the client must first be evaluated for competency before obtaining consent.
d. surgery can be performed without consent.

 

 

ANS:  D

Surgery can be performed without consent because it is a life-threatening emergency. Normally parents or a guardian must give consent, but in a life-threatening emergency medical care can be administered without consent. Providing proof of emancipation is not necessary in a life-threatening situation. The client does not need to first be evaluated for competency in a life-threatening situation.

 

DIF:    Cognitive Level: Application          REF:   p. 38

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. In regard to informed consent, which of the following statements is true?
a. Only legally incompetent adults can give consent.
b. Only parents can give consent for minor children.
c. It is not required that the client be told about costs and alternatives to treatment.
d. Consent must be voluntary.

 

 

ANS:  D

For legal consent to be valid, it must be voluntary. Only legally competent adults can give consent. Parents or legal guardians can give consent for minor children. Clients must have full disclosure about risks/benefits, including costs and alternatives.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 37

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The client has a living will in which he states he does not want to be kept alive by artificial means. The client’s family wants to disregard the client’s wishes and have him maintained on artificial life support. The most appropriate initial course of action for the nurse would be to
a. tell the family that they have no legal rights.
b. tell the family that they have the right to override the living will because the patient cannot speak.
c. report the situation to the hospital ethics committee.
d. allow the family to verbalize their feelings and concerns, while maintaining the role of client advocate.

 

 

ANS:  D

Allowing the family to verbalize their feelings and concerns is the most appropriate action at the time to help the family deal with their loss and come to terms with their family member’s wishes. Telling the family that they have no legal rights would not be supportive and might create hostility. The family does not have the right to override a living will. It is not the most appropriate initial course of action to report the situation to the hospital ethics committee. According to the American Nurses Association Code of Ethics for Nurses, the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

 

DIF:    Cognitive Level: Analysis               REF:   p. 27

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Management of Care

 

  1. The nurse collects both objective and subjective data. An example of subjective data is
a. BP 140/80.
b. skin color jaundiced.
c. “I have a headache.”
d. history of seizures.

 

 

ANS:  C

Subjective data refers to the client’s perception of data and what the client or family says about the data. Objective data refers to data that are directly observable or verifiable through physical examination or tests. Blood pressure recording is objective. Jaundiced skin color observation by the nurse is objective data. A history of seizures is objective data.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 33

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse observes a client pacing the floor. The nurse validates an inference when speaking to the client by stating,
a. “You are anxious, so let’s talk about it.”
b. “Let’s try some deep breathing to help you relax.”
c. “You seem anxious. Will you tell me what is going on?”
d. “Clients who pace usually need to talk to a physician. Should I call yours?”

 

 

ANS:  C

The nurse has inferred that the client is anxious but needs to ask further questions to validate the information. A nurse should not make assumptions without first confirming that the inference is correct. Deep breathing exercise is an intervention; it is not validating an inference.

 

DIF:    Cognitive Level: Application          REF:   p. 33

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client who is scheduled for a bilateral inguinal hernia repair the next day is observed pacing the unit. After validating that the client is anxious about his upcoming surgery because he is afraid of pain, a relevant nursing diagnosis would be
a. anxiety related to surgery.
b. pain related to anxiety about surgery as evidenced by pacing.
c. anxiety related to fear of postoperative pain as evidenced by pacing.
d. pacing related to fear of postoperative pain.

 

 

ANS:  C

Anxiety is the problem to be addressed. Related to connects the problem to the etiology (fear of pain). The third part of the statement identifies the clinical evidence (pacing) that supports the diagnosis. There are three parts to a nursing diagnosis, and the anxiety is related specifically to fear of pain after surgery. The problem to be addressed is the anxiety, not the pain, at this time. “Pacing related to fear of postoperative pain” contains only two parts to this statement. Pacing is the evidence, not the problem.

 

DIF:    Cognitive Level: Application          REF:   p. 33

TOP:   Step of the Nursing Process: Nursing Diagnosis

MSC:  Client Needs: Management of Care

 

  1. Which of the following is an outcome for a client with a broken leg?
a. Client will develop an ambulation program within 1 month.
b. Encourage client to ambulate with cast using crutches.
c. Client asks, “When will I walk again?”
d. Client experiences alteration in mobility related to a broken leg.

 

 

ANS:  A

Outcomes are goals that are measurable, achievable, and client centered. Ambulation is a nursing intervention. A question from the client is not an outcome; it is a question. “Client experiences alteration in mobility related to a broken leg” is part of a nursing diagnosis.

 

DIF:    Cognitive Level: Application          REF:   pp. 34-35

TOP:   Step of the Nursing Process: Outcome Identification

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching a client who is alert and oriented about the drug warfarin. When teaching the client about this drug, the nurse emphasizes the need to be consistent with Vitamin K intake, which is found primarily in green leafy vegetables. When the client’s spouse comes to visit, the client states, “I can no longer consume green leafy vegetables.” This is an example of what type of failure caused by a communication problem?
a. System failure
b. Reception failure
c. Transmission failure
d. Global aphasia

 

 

ANS:  B

Communication problems occur when there are failures in one or more categories: the system, the transmission, or in the reception. Reception failures occur when channels exist and necessary information is sent, but the recipient misinterprets the message. System failures occur when the necessary channels of communication are absent or not functioning. Transmission failures occur when the channels exist but the message is never sent or is not clearly sent.

 

DIF:    Cognitive Level: Analysis               REF:   p. 23

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. When setting goals with a client, the nurse demonstrates which step of the nursing process?
a. Assessment
b. Planning
c. Implementation
d. Evaluation

 

 

ANS:  B

Outcome identification occurs during the planning phase. Goals are identified during planning, not assessment. Nursing interventions are performed during the implementation phase. During evaluation, goal achievement is evaluated.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 35

TOP:   Step of the Nursing Process: Outcome Identification and Planning

MSC:  Client Needs: Management of Care

 

  1. When the nurse identifies a health problem or alteration in a client’s health status that requires a nursing intervention, the nurse is performing which step of the nursing process?
a. Diagnosis
b. Planning
c. Intervention
d. Evaluation

 

 

ANS:  A

The nursing diagnosis consists of three parts: (1) problem, (2) etiology, and (3) evidence. The problem is a statement identifying a health problem or alteration in a client’s health status requiring nursing intervention. Planning occurs after problem identification. Interventions occur during implementation. The effectiveness of the interventions is evaluated in the evaluation phase.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 33

TOP:   Step of the Nursing Process: Diagnosis

MSC:  Client Needs: Management of Care

 

  1. When evaluating the client’s progress toward goal achievement, the nurse should ask which of the following questions?
a. “Did the client tell the truth?”
b. “Were the goals realistic?”
c. “Did the physician diagnose the client’s condition correctly?”
d. “Was the length of stay too short?”

 

 

ANS:  B

The goals need to be realistic and achievable in the time frame allotted for the interventions to be effective. Validation of information occurs in the assessment phase. Medical diagnosis is not part of the nursing process. The nurse needs to work within the time frame allotted.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 34

TOP:   Step of the Nursing Process: Evaluation

MSC:  Client Needs: Management of Care

 

  1. The plan of care serves as the structural framework for
a. maintaining confidentiality.
b. attaining self-actualization.
c. maintaining therapeutic communication.
d. providing safe, high-quality care.

 

 

ANS:  D

The plan of care plan serves as the structural framework for providing safe, high-quality care. Its purpose is to provide continuity and supply a basis for interventions and documentation of client progress. Each plan of care should be individualized to reflect client values, clinical needs, and preferences. Confidentiality is defined as providing only the information needed to provide care for the client to other health professionals who are directly involved in the care of the client. The nurse can use Maslow’s hierarchy of needs to prioritize goals and objectives. Therapeutic communication helps the nurse use the nursing process.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 35

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The nurse is caring for a client whose health has suddenly worsened. The nurse calls the health care provider. What is the best example of the nurse communicating to the health care provider using the situation part of SBAR communication?
a. “The patient has developed dyspnea with audible crackles in the lungs bilaterally; oxygen saturation is 86% on room air.”
b. “The patient has chronic obstructive pulmonary disease due to a long-term history of smoking.”
c. “I am concerned that the patient is exhibiting signs of a pulmonary embolus due to a sudden drop in oxygenation.”
d. “I would like for you to order a STAT chest x-ray because the patient has suddenly developed shortness of breath with hypoxia.”

 

 

ANS:  A

Situation: What is going on with the client? Background: What is key information/context? Assessment: What do I think the problem is? Recommendation: What do I want to be done?

 

DIF:    Cognitive Level: Analysis               REF:   p. 24

TOP:   Step of the Nursing Process: All phases of the nursing process

MSC:  Client Needs: Management of Care

 

  1. During a routine visit, the nurse notes that a child has several bruises at various stages of healing. The child reports having fallen down. Failure to report these findings is an example of
a. negligence.
b. reasonable prudence.
c. maintenance of confidentiality.
d. HIPAA regulation.

 

 

ANS:  A

Failing to report suspected physical or sexual child abuse is an example of a negligent act. Reasonable prudence is a nursing action that a reasonably prudent nurse would perform. In a situation where a child has several bruises, confidentiality must be breached. HIPAA regulations protect the privacy of client records.

 

DIF:    Cognitive Level: Application          REF:   p. 37

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Management of Care

 

MULTIPLE RESPONSE

 

  1. When practicing effective and correct communication, the nurse should (Select all that apply.)
a. speak in a clear voice.
b. be concise when providing client education.
c. be concrete when communicating with clients.
d. focus entirely on abstract communication techniques with clients.
e. ensure that communication with clients is complete.
f. provide courteous communication when interacting with clients.

 

 

ANS:  A, B, C, E, F

Effective and correct communication is: clear, concise, concrete, complete, and courteous.

 

DIF:    Cognitive Level: Analysis               REF:   p. 23

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

Chapter 5: Developing Therapeutic Communication Skills

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. When therapeutically communicating with a client who has just found out he is HIV- positive, the nurse should focus on
a. professional needs.
b. an unlimited time frame for communication.
c. verbal communication only between the client and the nurse.
d. achieving identified health-related goals.

 

 

ANS:  D

Therapeutic communication is defined as a dynamic interactive process consisting of words and actions and entered into by a clinician and client for the purpose of achieving identified health-related goals. Originally conceptualized by Jurgen Ruesch in 1961, communication skills are essential drivers for developing therapeutic relationships and facilitating interdisciplinary collaborative communication with clients and families. Fundamental forms of health communication include verbal and written words and nonverbal communicative behaviors.

 

DIF:    Cognitive Level: Application          REF:   p. 75

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse demonstrates understanding of the concept of metacommunication through
a. recognizing the impact of communication on others.
b. actively listening with good eye contact.
c. implementing barriers to effective communication.
d. ensuring that verbal and nonverbal messages are incongruent.

 

 

ANS:  B

Metacommunication refers to how nonverbal cues are used to enhance or negate the meaning of words. In addition to observable nonverbal behavior, client choices about clothing, personal and religious items, hairstyle and hygiene, and voluntary use of gestures inform, add to, and complete verbal messages. Behavioral communication is influenced by life circumstances, culture, and immediate context, so it is susceptible to misinterpretation and requires validation.

 

DIF:    Cognitive Level: Application          REF:   p. 76

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. When communicating with a client, the nurse recognizes that a barrier to effective communication is
a. cultural sensitivity.
b. thinking ahead to the next question.
c. completion of physical care in a nonhurried manner.
d. focusing on the current questions asked by the client.

 

 

ANS:  B

Barriers to effective communication within the nurse occur when the nurse is not fully engaged with the client because of thinking ahead to the next question; when the nurse has cultural stereotypes and biases; and when the nurse is in a hurry to complete physical care.

 

DIF:    Cognitive Level: Application          REF:   p. 79

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. When communicating with clients, the nurse actively uses listening responses. Which of the following types of listening response should the nurse use?
a. Moralizing
b. Giving advice
c. False reassurance
d. Paraphrasing

 

 

ANS:  D

Paraphrasing is an example of a listening response that focuses on the client. Moralizing, giving advice, and false reassurances are all examples of negative listening responses.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 86| p. 88

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse enters a client’s room with the intent of allowing the client to express feelings in relation to her new cancer diagnosis. The nurse notices that the client is crying and guarding her incision site. After validating physical discomfort, the nurse should
a. administer an analgesic and postpone the interaction.
b. sit with the client and hold her hand.
c. explain that pain is expected following surgery but that it is important to increase activity to avoid complications.
d. acknowledge the physical pain but state that it is a priority to immediately address the emotional pain.

 

 

ANS:  A

Communication breaks down when the nurse and client do not share the same understanding of messages. Barriers to effective communication occur in clients when they are preoccupied with pain, physical discomfort, worry, or contradictory personal beliefs. The client’s pain must be a priority for the nurse before other needs are addressed.

 

DIF:    Cognitive Level: Analysis               REF:   p. 78

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A nurse is conducting a medication education group for mentally ill clients. One of the clients states, “I don’t think everyone needs medications. What about psychotherapy? Can you tell me about that?” What is an appropriate response by the nurse?
a. Talk to the group about the benefits of psychotherapy.
b. Tell the group that psychotherapy is ineffective and they need medication.
c. Acknowledge the question, but explain the time limitations and focus of that particular group.
d. Explain that it is the physician’s decision what type of treatment modality is for each client

 

 

ANS:  C

In the past, nurses had more time with clients. Today nurses must make every second count. Nurses and clients need to select the most pressing health care needs for attention. The nurse should focus on what is essential to know, rather than what might be nice to know. This requires planning and sensitivity to client needs and preferences. Client readiness and capabilities are other factors to take into consideration in selecting content. Unless it is an emergency situation, the nurse can guide but not insist on a particular point of discussion.

 

DIF:    Cognitive Level: Application          REF:   p. 92

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. When teaching a client how to administer insulin, the nurse recognizes that the best method of communicating therapeutically with the client is to
a. talk to the client in the visitors’ lounge.
b. talk to the client within his personal space.
c. communicate with the client using touch.
d. face the client while leaning slightly forward.

 

 

ANS:  D

Privacy, space, and timing are other aspects to consider. Clients need privacy, to be free from interruption, and to have their space requirements respected to fully engage in meaningful conversations. Therapeutic conversations typically take place within a social distance (3-4 feet is optimal). Touch has contextual and cultural meanings. Women are more likely to welcome and use touch in communication. Touch is a valued form of communication in some cultures. In others, touch is reserved for religious purposes or is seldom used as a form of communication, for example in Asia. Before touching a client, assess the client’s receptiveness to touch. Observing the client will provide some indication, but you may need to ask for validation. If the client is paranoid, out of touch with reality, verbally inappropriate, or mistrustful, touch is contraindicated as a listening response. Minimal physical cues (e.g., leaning towards the client, nodding, smiling) are used to accentuate words and to connect with people nonverbally as well as verbally.

 

DIF:    Cognitive Level: Application          REF:   p. 76

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. When conducting an assessment interview, which of the following is the best communication technique for the nurse to use?
a. Ask multiple questions at the same time
b. Offer limited time for the client to respond to each question that is asked
c. Use short, unambiguous listening responses focused on current health issues and client concerns
d. Ensure that all questions are answered immediately in order to avoid the need for related follow-up questions to clarify

 

 

ANS:  C

A client-centered interview begins with encouraging clients to tell the story of their illness. This format helps nurses integrate personal with medical perspectives. Using short, unambiguous listening responses focused on current health issues and client concerns is the best means of helping clients tell their story. With relevant queries you will get a better idea of how the client communicates and what clients consider most important about their clinical situation. In addition to using a “here and now” approach, avoid asking more than one question at a time, and allow enough time for the client to fully answer. Related follow-up questions to clarify or help clients expand on what has been introduced can be helpful.

 

DIF:    Cognitive Level: Application          REF:   p. 82

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse asks a newly admitted client, “Can you tell me what brought you to the hospital today?” The purpose of an open-ended question is to
a. influence the direction of an acceptable response.
b. encourage the client to answer the question with a one-word response.
c. allow clients latitude in telling their story.
d. allow the client to engage in a passive relationship with the nurse.

 

 

ANS:  C

Open-ended questions permit clients to express health problems and needs in their own words. They are especially helpful at the start of a relationship, when the nurse’s objective is to gather information and to get to know the client as a person. You are more likely to elicit a client’s values, preferences, and ways of thinking about their illness if you allow them latitude in telling their story through open-ended questions. Sharing the personal meanings of an illness rather than identifying a diagnosis or listing discrete symptoms helps the client and nurse link the context of a health disruption with symptoms and provides more complete information. An open-ended question is similar to an essay question on a test. It is open to interpretation and cannot be answered by “yes,” “no,” or a one-word response. Open-ended questions ask clients to think and reflect on their situation. They help connect relevant elements of the client’s experience without influencing the direction of the response. (e.g., relationships, impact of the illness on self or others, environmental barriers, potential resources). Open-ended questions are used to elicit the client’s thoughts and perspectives without influencing the direction of an acceptable response.

 

DIF:    Cognitive Level: Application          REF:   p. 82

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following is the best questioning sequence during a client interview in which the client is communicative and not in an emergency situation?
a. Begin with focused questions and proceed to open-ended questions.
b. Begin with open-ended questions and proceed to focused questions.
c. Begin with closed questions and proceed to open-ended questions.
d. Begin with open-ended questions and proceed to closed questions.

 

 

ANS:  B

Start with open-ended questions to allow the client to tell his or her story in his or her own way to obtain general information. Use focused questions to obtain more specific information Start with open-ended, not focused or closed, questions. Proceed to focused questions, not closed questions.

 

DIF:    Cognitive Level: Application          REF:   pp. 82-83

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client is admitted to the hospital for unsteady gait resulting in frequent falls. Which of the following is a circular question that the nurse could ask this client?
a. “Tell me more about your falls at home.”
b. “How will this hospitalization affect your family?”
c. “Have you experienced dizziness and imbalance before?”
d. “Can you tell me what brought you here?”

 

 

ANS:  B

Circular questions are a form of focused questions, which give attention to the interpersonal context in which an illness occurs. These are used to explore the impact of a health disruption on family functioning and relationships with significant others. “Tell me more about your falls at home” is a focused question. “Have you experienced dizziness and imbalance before?” is a closed-ended question. “Can you tell me what brought you here?” is an open-ended question.

 

DIF:    Cognitive Level: Application          REF:   p. 83

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client states, “I can’t sleep all night because the nurses are noisy.” Which of the following responses by the nurse best represents the nurse’s recognition of the client’s theme?
a. “I will speak to the supervisor about your complaint.”
b. “You cannot sleep because of the noise level at night?”
c. “You need to understand that nurses communicate with other clients during the night.”
d. “I will tell the night nurses that you complained.”

 

 

ANS:  B

Listening for themes requires observing and understanding what the client is not saying, as well as what the person actually reveals. Identifying the underlying themes presented in a therapeutic conversation can relieve anxiety and provide direction for individualized nursing interventions. Speaking to a supervisor, explaining that nurses communicate with other clients during the night, and telling the night nurse of the complaint are actions by the nurse, not identification of themes.

 

DIF:    Cognitive Level: Application          REF:   pp. 83-84

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client states, “I don’t know about taking this medicine the doctor is putting me on. I’ve never had to take medication before, and now I have to take it twice a day.” The nurse’s response is, “It sounds like you don’t know what to expect from taking the medication.” The nurse’s response is an example of which of the following?
a. Clarification
b. Paraphrasing
c. Restatement
d. Validation

 

 

ANS:  B

Paraphrasing is a listening response, which focuses on the cognitive component of a message. It is used to check whether the nurse’s translation of the client’s words represents an accurate interpretation of the message. The strategy takes the essential information expressed in the client’s original message and presents it in a shorter, more specific form, without losing its meaning. The focus is on the core elements of the original statement: “In other words, what I think I hear you saying is,” or “let me understand, are you saying that….?”  Clarification is a listening response, used to ask clients for more information or for elaboration on a point. The strategy is useful when parts of a client’s communication are ambiguous or not easily understood. Failure to ask for clarification when part of the communication is poorly understood means that the nurse will act on incomplete or inaccurate information. For example, you could say, “May I tell you what I have understood so far, and see if you think I understand your situation? Restatement is an active listening strategy used to broaden a client’s perspective or provide a sharper focus on a specific part of the communication. Restating a self-critical or irrational part of the message in a questioning manner focuses the client’s attention on the possibility of an inaccurate or global assertion. Restatement is particularly effective when the client overgeneralizes or seems stuck in a repetitive line of thinking. To challenge the validity of the client’s statement directly could be counterproductive, whereas repeating parts of the message in the form of a query serves a similar purpose without raising defenses; for example, “Let me see if I have this right…”

Validation is a special form of feedback, used to ensure that both participants have the same basic understanding of messages. Simply asking clients whether they understand what was said is not an adequate method of validating message content. Validation can provide new information that helps the nurse frame comments that match the client’s need.

 

DIF:    Cognitive Level: Application          REF:   pp. 87-88

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. The student nurse is working on an assignment in which she has to interview a fellow student nurse for 30 minutes. The fellow student nurse talks about career plans, possible jobs after graduation, and her part-time work. After 10 minutes, she has stopped talking and both student nurses sit in silence. Which of the following is the best response by the interviewing student nurse?
a. “Tell me more about how you selected your career goals.”
b. “Who is the most significant person in your life?”
c. “What impact will these plans have on your life?”
d. Remain silent until the fellow student nurse breaks the silence.

 

 

ANS:  C

An open-ended question is usually just the introduction, requiring further dialogue about relevant topics. Ending the dialogue with a general open-ended question such as, “Is there anything else that is concerning you right now?” can provide relevant information that might otherwise be overlooked. Asking a focused question allows the interviewer to obtain more specific information. “Who is the most significant person in your life” is a closed-ended question that is limiting. A silent pause can be helpful, but long silences can become uncomfortable.

 

DIF:    Cognitive Level: Application          REF:   pp. 82-83

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. As the nurse communicates with a client, the feedback provided by the nurse should be
a. descriptive, general, and content focused.
b. client focused and evaluative.
c. well-timed and general.
d. specific and focused on observed behavior.

 

 

ANS:  D

Feedback is a response message related to specific client behaviors and words. Nurses give and ask for client feedback to ensure mutual understanding. Feedback can focus on the content, the relationship between people and events, the feelings generated by the message, or parts of the communication that are not clear. Feedback should be specific and focused on observed behavior. Analyzing a client’s motivations make clients defensive. Feedback should be a two-way process. Feedback responses reassure the client that the nurse is fully attentive to what the client is communicating. When it offers a neutral mirror, clients are able to view a problem or behavior from a different perspective. Feedback is most relevant when it only addresses the topics under discussion and doesn’t go beyond the data presented by the client. Feedback provided to nurses about their health teaching helps them to individualize teaching content and methodology to better facilitate the learning process.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 92

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client tells the nurse, “I am having a tough time and I am scared about the future.” Which of the following responses by the nurse is the best feedback?
a. “I know what you mean.”
b. “You should do something about it.”
c. “I really don’t think you are having a tough time.”
d. “You are having a tough time and you are scared.”

 

 

ANS:  D

Feedback is a response message related to specific client behaviors and words. Nurses give and ask for client feedback to ensure mutual understanding. Feedback can focus on the content, the relationship between people and events, the feelings generated by the message, or parts of the communication that are not clear. Feedback should be specific and focused on observed behavior. Analyzing a client’s motivations make clients defensive. Feedback should be a two-way process. Feedback responses reassure the client that the nurse is fully attentive to what the client is communicating. When it offers a neutral mirror, clients are able to view a problem or behavior from a different perspective. Feedback is most relevant when it only addresses the topics under discussion, and doesn’t go beyond the data presented by the client. Feedback provided to nurses about their health teaching helps them to individualize teaching content and methodology to better facilitate the learning process. “I know what you mean” is disconfirming. “You should do something about it” and “I really don’t think you are having a tough time” are examples of responses that are judging or evaluating.

 

DIF:    Cognitive Level: Application          REF:   p. 92

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. When caring for a hospitalized client, the nurse demonstrates effective communication when
a. presenting several ideas at a time.
b. using vocabulary that is unfamiliar to the client.
c. stating key ideas only once.
d. putting ideas in a logical sequence of related material.

 

 

ANS:  D

Guidelines to effective verbal communication in the nurse-client relationship include putting ideas in a logical sequence of related material, focusing only on essential elements and presenting one idea at a time, keeping language as simple as possible through using vocabulary familiar to the client, and repeating key ideas.

 

DIF:    Cognitive Level: Application          REF:   p. 92

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following is true in relation to the use of humor?
a. Humor is most effective when building rapport.
b. Humor should focus on the client’s personal characteristics.
c. Humor and laughter have healing purposes.
d. Humor should dominate the situation.

 

 

ANS:  C

Humor and laughter have healing purposes. Laughter generates energy, and activates b-endorphins, a neurotransmitter that creates natural highs and reduces stress hormones. Humor is most effective when rapport is well established and a level of trust exists between the nurse and client. When humor is used, it should focus on the idea, event, or situation, or something other than the client’s personal characteristics. Humor should fit the situation, not dominate it.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 94-95

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity