Homework Lance
1.A nurse who works for an oncology unit is preparing to bathe a patient who recently underwent surgery to remove an abdominal tumor. Before beginning the bath, the nurse explains the procedure. Which of the following best describes the nurse’s communication role?
a.
Channel
b.
Receiver
c.
Message
d.
Sender
ANS: D
The nurse is the sender in this scenario. The sender is the person who delivers the message. The roles of sender and receiver change back and forth as two persons interact. The message is sent to a receiver, in this case the patient. The message is the content of the conversation; in this scenario explaining what will happen is the message. The channel is the means of conveying and receiving messages through visual, auditory, and tactile senses, the nurse’s spoken words in this scenario.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 185 OBJ: Describe the elements of the communication process.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
2.A patient is being cared for by a nurse. The patient has questions regarding what time the surgery is scheduled. When the nurse responds to the question, the nurse is assuming which communication role?
a.
Channel
b.
Receiver
c.
Message
d.
Sender
ANS: D
The nurse is the sender in this scenario because the nurse responds by speaking and sending a message, rather than just receiving the message. The sender is the person who delivers the message. The roles of sender and receiver change back and forth as two persons interact. The message is sent to a receiver, in this case the patient. The message is the content of the conversation; in this scenario the time of the surgery is the message. The channel is the means of conveying and receiving messages through visual, auditory, and tactile senses, the nurse’s spoken words in this scenario.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 185 OBJ: Describe the elements of the communication process.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
3.A registered nurse is a new nurse manager who needs to council an employee regarding attendance. Because the nurse manager is new to the position, the nurse is rehearsing what is planning to say to the employee before the meeting. The nurse is using which form of communication?
a.
Interpersonal
b.
Intrapersonal
c.
Public
d.
Private
ANS: B
Intrapersonal communication, also called self-talk, is a powerful form of communication that occurs within an individual. People “talk to themselves” by forming thoughts internally that strongly influence perceptions, feelings, behavior, self-concept, and performance. Self-talk is a mental rehearsal for difficult tasks or situations so that individuals deal with them more effectively. Interpersonal communication is interaction that occurs between two people or within a small group. When the nurse actually talks to the employee, it is called interpersonal communication. Public communication is the interaction of one individual with large groups of people. Private is not a level of communication.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF:186
OBJ:Describe the levels of communication and their uses in nursing.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
4.A nurse is working in a busy emergency department of an urban hospital. The family of a patient brought in by ambulance asks the nurse what the doctor meant when he or she said that the patient was coding. In this situation, the word coding is an example of which of the following?
a.
Denotative meaning
b.
Connotative meaning
c.
Intonation
d.
Pacing
ANS: A
Coding in this instance is a denotative meaning. A single word sometimes has several meanings. Individuals who use a common language share the denotative meaning of a word. The word baseball has the same meaning for all individuals who speak English, but the word code denotes cardiac arrest primarily to health care providers. The connotative meaning is the shade or interpretation of the meaning of a word, which is influenced by the thoughts, feelings, or ideas that people have about the word. Tone of voice and volume dramatically affect the meaning of a message, and emotions directly influence tone of voice, which is intonation. Pacing can involve talking rapidly, using awkward pauses, or speaking extremely slowly and deliberately, conveying different meanings.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:186
OBJ:Describe the levels of communication and their uses in nursing.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
5.A patient asked a nurse when the primary health care provider would make rounds. The nurse was taking another patient for a stat test and replied very quickly, “I have no idea.” The patient most likely interpreted the nurse as uncaring because of which factor?
a.
Vocabulary
b.
Pacing
c.
Timing
d.
Personal appearance
ANS: B
Because the nurse replied very quickly it is pacing. Talking rapidly, using awkward pauses, or speaking extremely slowly and deliberately conveys an unintended message. Vocabulary is the sender’s words and phrases. “I have no idea” is vocabulary that is understandable. Timing is critical in communication. The nurse used timing appropriately by answering the patient’s question. Personal appearance is not an issue in this scenario.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 186 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
6.A 9-year-old patient who is hospitalized for bowel surgery appears very frightened. To appear less threatening to the child, which action should the nurse take?
a.
Stand over the bed when talking to the patient.
b.
Sit in a chair next to the bed when talking to the patient.
c.
Maintain constant eye contact with the patient at all times.
d.
Stay within 12 inches of the patient when talking to the patient.
ANS: B
The nurse should sit in a chair next to the bed. A nurse appears less dominant and less threatening when interacting at the patient’s eye level. Looking down on a person (standing by the bed) establishes authority, but interacting at the same eye level indicates equality in the relationship. Constant eye contact can be intrusive or threatening to some people. Twelve inches is within the intimate zone and can be threatening.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 188 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7.A nurse went into a patient’s room at 0900, shortly after the patient was told that he or she had liver cancer. The patient asked the nurse to stay because he or she did not want to be alone. The nurse stood very close to the patient, held the patient’s hand, and told the patient that he or she had plenty of time. A few minutes later, the nurse thought to check the time on the wristwatch because the nurse was supposed to take another patient for a test at 0945. The patient saw the nurse look at the wrist watch and told the nurse it was now okay to be alone. What was the most likely reason the patient said it was okay for the nurse to leave?
a.
Invasion of personal space
b.
Verbal communication
c.
Nurse’s gesture
d.
Intonation
ANS: C
The nurse’s gesture of looking at the wrist watch most likely caused the request. Gestures alone carry specific meanings, or they may create messages with other communication cues. There was no invasion of personal space because the patient allowed the nurse to sit very close and hold hands. There was no inappropriate verbal communication (words or phrases), nor was there any inappropriate intonation (tone of voice).
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 188 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
8.A registered nurse is caring for a postoperative patient who is experiencing respiratory distress after the administration of pain medication. The nurse called the patient’s primary health care provider immediately. The information regarding the patient was conveyed using the SBAR format. Which information did the nurse convey to the primary health care provider?
a.
Situation, background, assessment, recommendation
b.
STAT, background, assessment, requirement
c.
Status, background, analysis, recommendation
d.
Setting, belief, assessment, requirement
ANS: A
SBAR stands for situation, background, assessment, and recommendation. Use of common language when communicating critical information helps prevent misunderstandings. SBAR has become a best practice for standardizing communication between health care providers. SBAR does not contain STAT, status, setting, analysis, belief, or requirement.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 190 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
9.Which behavior by the nurse would be considered most professional?
a.
Addressing a patient by “dear”
b.
Wearing small earrings
c.
Being task oriented
d.
Avoiding troublesome patients
ANS: B
Wearing small earrings is the most professional. The patient’s acceptance of a nurse as a professional often depends on the manner in which he or she presents a professional and caring image. Verbal and nonverbal behaviors influence the helping relationship. Professional appearance, demeanor, and behavior are important in establishing trustworthiness and competence. Calling a patient “honey,” “dear,” “grandpa,” or “sweetheart” rather than by a personal name is inappropriate. Being task oriented, or making a technical procedure (e.g., administration of a medicine) your priority, is another way of not being emotionally available. Do not avoid patients whose behavior is troublesome.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF:192
OBJ: Identify features and expected outcomes of the nurse-patient relationship.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
10.When caring for a patient from another culture, what is the best strategy for the nurse to use in communicating with the patient?
a.
Using a cultural joke to break the ice
b.
Stereotyping the patient within his or her culture
c.
Considering the context of the patient’s background
d.
Assuming the patient or the family member speaks English
ANS: C
When a patient is from another culture, the nurse should consider the context of the patient’s background. Accept patients’ rights to adhere to cultural customs and norms. Persons of different cultures use different types of verbal and nonverbal cues to convey meaning. A nurse should make a conscious effort not to interpret messages through his or her own cultural perspective; instead, a nurse considers the context of the other individual’s background. Avoid stereotyping persons from other cultures or making jokes about them. With patients from another culture, the nurse cannot assume the patient or family members can speak English.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:194
OBJ: Explain the focus of communication within each phase of the nursing process.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
11.A patient had a stroke that left the patient aphasic. A nurse is working on a plan of care. Which nursing diagnosis should the nurse use to describe the patient’s aphasia?
a.
Impaired Verbal Communication
b.
Anxiety
c.
Impaired Social Interaction
d.
Ineffective Coping
ANS: A
Impaired Verbal Communication is the nursing diagnostic label to describe a patient who has limited or no ability to communicate verbally. This diagnosis is useful for a wide variety of patients with special problems and needs related to communication. It is defined as difficulty or inability to use or understand language in interpersonal reactions. Anxiety is not the same thing as aphasia. Although impaired social interactions could be used, based upon the question (diagnosis for patient’s aphasia), impaired verbal communication is most appropriate. There are no data in the scenario to say the patient is not interacting with others. There are no data to support ineffective coping; it just says the patient is aphasic but no data address coping.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:195
OBJ: Explain the focus of communication within each phase of the nursing process.
TOP: Nursing Process: Diagnosis MSC: NCLEX: Management of Care
12.A patient is aphasic from a recent stroke. The nurse is taking a multidisciplinary approach to this patient’s care. Who would be most appropriate for the nurse to collaborate with regarding the patient’s aphasia?
a.
Interpreter
b.
Speech therapist
c.
Physical therapist
d.
Mental health nurse specialist
ANS: B
Speech therapists help patients with aphasia. The nurse should collaborate with other health care providers who have expertise in communication strategies. Interpreters are invaluable when a patient speaks a foreign language. Mental health advanced practice nurses help in communicating with angry or highly anxious patients. Physical therapist would help with mobility issues.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:195
OBJ: Explain the focus of communication within each phase of the nursing process.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
13.A nurse is spending time with a patient, who has recently been diagnosed with breast cancer. The patient states that he or she is frightened about the diagnosis and feels overwhelmed. The nurse responds, “It sounds to me like you are feeling very scared right now.” Which communication technique did the nurse use?
a.
Sympathy
b.
Empathy
c.
Focusing
d.
Self-disclosure
ANS: B
Empathy is the ability to understand and accept another person’s perspective. Although no one can ever totally know another’s experiences, a nurse can try to understand what the person is experiencing. Focusing directs conversation to a specific topic or issue when a discussion becomes unclear. Self-disclosures are personal statements intentionally revealed to the other person. Sympathy is the concern, sorrow, or pity that you feel for a patient when you personally identify with his or her needs. Unlike empathy, which tries to understand a patient’s experience, sympathy takes a subjective look at the patient’s world (“Oh, I know just what you mean. I hate feeling that way.”).
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 195 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
14.A patient has just been admitted to the hospital with a broken hip from a fall in the home. The nurse admitting the patient is practicing active listening. Which behavior best conveys to the patient that the nurse is using active listening?
a.
Keeping arms crossed
b.
Sitting facing the patient
c.
Standing facing the patient
d.
Leaning away from the patient
ANS: B
The best behavior is sitting facing the patient. Active listening enhances trust because the nurse communicates acceptance and respect for the patient. Several nonverbal skills facilitate attentive listening, which are identified by the acronym SOLER:
Sit facing the patient.
Observe an open posture.
Lean toward the patient.
Establish and maintain eye contact.
Relax.
Keeping arms crossed is a closed posture. Leaning toward, not away, from the patient is active listening. Sitting, not standing, is best.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 196 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
15.A nurse is caring for a patient who is having abdominal pain and is experiencing difficulty sleeping. The nurse sits at the bedside of the patient and takes the patient’s hand. The patient quickly pulls back. How should the nurse interpret this patient’s behavior?
a.
The patient is uncomfortable with being touched.
b.
The patient is unable to express feelings.
c.
The patient has impaired social skills with others.
d.
The patient has difficulty with nonverbal communication.
ANS: A
Nurses need to remain sensitive to his or her responses as well as the patient’s feelings. If a patient refuses to hold a nurse’s hand while in pain or pulls away from physical contact, this signals that the patient is uncomfortable with being touched by the nurse. It does not imply impaired social skills, inability to express feelings, or difficulty with nonverbal communication.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 199 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
16.A nurse is assisting in the admission of a patient to the orthopedic unit of the hospital and is obtaining information for the database. Which technique is the best way for the nurse to obtain information from the patient?
a.
Ask personal questions so as to show interest.
b.
Use medical vocabulary to appear competent.
c.
Ask why the patient waited so long to get treatment.
d.
Use silence while the patient collects his or her thoughts.
ANS: D
Most people have a natural tendency to fill empty spaces with words, but sometimes silence is useful when they face decisions that require much thought. Nontherapeutic techniques discourage further expression of feelings and ideas and engender negative responses or behaviors in others. Asking irrelevant personal questions simply to satisfy your curiosity is inappropriate and invasive and nontherapeutic. Limit questions to health-related information. Health care professionals have their own culture and language. Using technical words in discussions with patients can cause confusion and anxiety. Avoid excessive use of such terms or translate them into lay terms. Sometimes asking “why” implies an accusation and results in resentment, insecurity, and mistrust.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 196 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
17.A nurse gives a hand-off report to the oncoming staff nurse. Which type of communication does this illustrate?
a.
Gossip
b.
Validation
c.
Interpersonal
d.
Intrapersonal
ANS: C
Interpersonal communication is interaction that occurs between two people or within a small group. Gossiping violates confidentiality. The act of validation requires comparing data with another source. Intrapersonal communication occurs within the individual, consisting of self-talk, self-verbalization, or inner thoughts.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF:186
OBJ:Describe the levels of communication and their uses in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
18.A nurse is caring for a patient who is visually impaired. Which technique should the nurse use to facilitate communication?
a.
Touch the patient before speaking.
b.
Identify self when entering the room.
c.
Quietly leave the room when finished.
d.
Keep the room dimly lit for calmness.
ANS: B
For a visually impaired patient, identify yourself when entering the room. The nurse should communicate verbally before touching the patient who is visually impaired. Notify the patient when leaving the room; do not quietly leave the room when finished as the patient will think you are still in the room. Ensure that lighting is adequate for the patient to see the speaker; do not keep it dimly lit.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:200
OBJ: Explain techniques used to assist patients with special communication needs.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
19.A nurse is caring for a patient who cannot speak clearly. Which technique should the nurse use to enhance conversation with this patient?
a.
Speak loudly.
b.
Finish the patient’s sentences.
c.
Ask question that require “yes” or “no” answers.
d.
Avoid communication aids to prevent embarrassment.
ANS: C
For patients who are mute, unable to speak, or cannot speak clearly, ask simple questions that require “yes” or “no” answers. Use normal volume and do not shout or speak too loudly. Do not finish the patient’s sentences. Use communication aids as needed; do not avoid them.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:200
OBJ: Explain techniques used to assist patients with special communication needs.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
20.A nurse forms a contract with the patient to specify roles during a therapeutic helping relationship. The nurse is in which phase of the therapeutic relationship?
a.
Working
b.
Termination
c.
Pre-interaction
d.
Orientation
ANS: D
During the orientation phase when you and the patient meet and get to know one another is the time when the contract is formed. During the working phase the nurse and patient work together to solve problems and accomplish goals. During the termination phase the helping relationship is ended. In the pre-interaction stage the nurse gathers information from various sources about the patient.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:190
OBJ:Describe a nurse’s focus within each phase of a therapeutic nurse-patient relationship.TOP:Nursing Process: Evaluation
MSC: NCLEX: Psychosocial Integrity
21.A nurse enters a patient’s room and sees the patient grimacing with each movement. When the nurse asks in a normal tone of voice how the patient is feeling, the patient states that he or she “feels fine.” Which finding will the nurse classify as nonverbal communication?
a.
The nurse’s tone of voice is normal.
b.
The patient states that he or she “feels fine.”
c.
The nurse asks how the patient is feeling.
d.
The patient grimaces with each movement.
ANS: D
The patient grimacing with each movement is nonverbal communication. Nonverbal communication includes messages sent through the language of the body, without the use of words. Nonverbal forms of communication include use of facial expressions, eyes, gestures, posture, and physical appearance. Nonverbal communication often reveals physical feelings. Tone of voice, asking questions, and saying that he or she feels fine are examples of verbal communication. Verbal communication involves the use of words or phrases and includes intonation, pacing, denotative and connotative meanings, volume, clarity, brevity, timing and relevance.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 187 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
22.While a patent is being interviewed by the nurse, a family member states, “What my father really means is that he doesn’t know for sure what the physician meant about the medical diagnosis.” Which communication technique did the family member use?
a.
Focusing
b.
Clarifying
c.
Summarizing
d.
Sharing observations
ANS: B
The family member’s statement is clarifying. Clarifying validates whether the person interpreted the message correctly. Focusing directs conversation to a specific topic or issues when a discussion becomes unclear. Summarizing provides a concise review of main ideas. Sharing observations is commenting on a patient’s appearance and how he or she sounds and acts such as, “I see you didn’t eat any breakfast.”
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 196 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
23.Which technique should the nurse use when providing information to a patient with a health literacy level of fifth grade?
a.
Use the passive voice of language.
b.
Present the most important information first.
c.
Shift from subject to subject until the patient responds.
d.
Explain using jargon so the patient will understand others on the health care team.
ANS: B
To promote understanding in a patient with a health literacy level of fifth grade is to present the most important information first. Use the active voice instead of passive. Break complex information into understandable chunks; do not shift from subject to subject. Use simple language, avoid medical jargon.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:189
OBJ: Discuss the principles of plain language for promoting health literacy.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
24.Which technique by the nurse will facilitate communication with an older adult?
a.
Have the TV play lightly in the background.
b.
Ask several questions in a row.
c.
Allow reminiscing.
d.
Use long sentences.
ANS: C
Allow older adults the opportunity to reminisce. Reminiscing has therapeutic properties that increase the sense of well-being. During conversation maintain a quiet environment that is free from background noise (turn off the TV). Allow time for conversation; do not ask several questions in a row. Avoid long sentences to explain the subject. Try to keep it short, simple, and to the point.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:201
OBJ: Discuss effective communication for patients of varying developmental levels.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1.A nurse has just admitted a 5-year-old child for suspected appendicitis. Which therapeutic communication techniques should the nurse use while communicating with this child? (Select all that apply.)
a.
Avoid sudden movements or gestures.
b.
Use simple, direct language.
c.
Sit at the child’s eye level.
d.
Tell the child exactly what can do.
e.
Use drawing or toys as needed.
ANS: A, B, C, E
Sudden movements or gestures can be frightening so they need to be avoided. When giving explanations or directions, use simple, direct language and be honest. Meet a child at eye level. Drawing and playing with young children allows them to communicate nonverbally (making the drawing) and verbally (explaining the picture). Telling the child exactly what can do is inappropriate. Remain calm and gentle and, if possible, let a child make the first move.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:201
OBJ: Discuss effective communication for patients of varying developmental levels.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
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