Communication in the Nurse-Patient Relationship

The nurse completes the admission process of a patient to an acute care facility. Which statement by the nurse demonstrates the communication technique of focusing?
A)
“You have been having a great deal of fatigue for the last 3 months.”
B)
“You are hoping to figure out the cause of your extreme fatigue during this hospital stay.”
C)
“You are frustrated because you are too tired to perform normal acitivities.”
D)
“You are unsure of what helps or prevents your fatigue.”
Ans:
B

Feedback:

This statement focuses on what the patient’s chief complaint is and the goal for this admission. The other statements demonstrate the communication technique of clarifying.

The nurse is communicating with a patient following a routine physical examination. Which statement best demonstrates summarization of the appointment?
A)
“I think all went well with your physical, don’t you?
B)
“Do you have any questions about all that was discussed during the exam?”
C)
“We reviewed your plans for your new diet and medications. Do you have any other questions?”
D)
“Will we see you in 6 months to see how your diet has progressed?”
Ans:
C

Feedback:

Summarization highlights the important points of a conversation or interaction. Reminding the patient that the diet plan and new medications were discussed best summarizes the appointment.

The student nurse is practicing communication skills by talking with several different patients in the hospital. In which instances would silence be appropriate? (Select all that apply)
A)
Allowing the patient time to reflect on his or her thoughts
B)
Reflecting on the communication that has occurred
C)
After asking the patient a question
D)
When the patient is upset and needs time to compose himself
E)
When the nurse doesn’t know the answer to a question
Ans:
A, B, C, D

Feedback:

Silence allows a pause in communication that gives the nurse and patient time to reflect on the conversation that has taken place. When the nurse waits quietly and attentively, the patient feels encouraged to initiate and maintain conversation, or to simply offer support. Not knowing the answer to a question is not an appropriate use of silence.

The community health nurse is preparing a campaign to educate the public about heart health. Which forms of verbal communication will be effective? (Select all that apply)
A)
Television
B)
Radio
C)
Posters
D)
Voice tone
E)
Brochures
Ans:
A, B, C, E

Feedback:

Forms of verbal communication that will convey the message in various forms include television, radio, posters, and brochures. Tone of voice is considered nonverbal communication.

The nurse is providing teaching to a patient who sometimes has difficulty remembering information. Which form of communication will be most helpful for this patient?
A)
Verbal communication
B)
Meta-communication
C)
Non-verbal communication
D)
Written communication
Ans:
D

Feedback:

While all forms of communication can be used during teaching, it will be essential to use written communication for this patient. This will allow the patient to refer back to important points presented.

The student nurse is studying the concepts of communication. Which description demonstrates the student understands the concept of feedback?
A)
The sender sends a clear message that is understood by the receiver.
B)
The receiver listens to the sender in an unassuming way.
C)
Feedback occurs when the sender and the receiver use one another’s reactions to produce further messages.
D)
The sender’s message is translated into a code, using verbal and nonverbal communication.
Ans:
C

Feedback:

Feedback can occur when a message is decoded and received.

The patient is talking to the nurse about recent health problems of immediate family members and the strain she has been under trying to care for them. She begins to cry between sentences. What response by the nurse demonstrates the most empathy?
A)
“I know how you feel. I was the primary caregiver for my father when he was dying.”
B)
“It’s okay to cry. Sometimes that helps us to feel better.”
C)
“Just take your time. I am listening.”
D)
“It is difficult when family members are ill. It helps if you take some time for yourself.”
Ans:
C

Feedback:

This response allows the patient to collect her thoughts while also expressing emotion, and it lets the patient know the nurse is there for her. Using appropriate periods of silence rather than talking away the patient’s feelings is empathetic. “I know how you feel” does not focus on the patient’s feelings, and stating “It’s okay to cry” or “Take some time for yourself” are statements that indicate the need for the patient to seek approval for her to experience her own feelings.

The nurse caring for a patient with a recent head injury asks the patient to raise his left arm as high as possible. The patient repeatedly raises his right arm. What does this indicate?
A)
Difficulty with providing feedback
B)
Difficulty with decoding messages
C)
Difficulty with compliance
D)
Difficulty with following commands
Ans:
B

Feedback:

Decoding refers to the receiver of communication being able to understand the sender’s message. This patient does not display noncompliance or difficulty following commands since he repeatedly raises the opposite arm. It is likely that the head injury has affected the patient’s ability to understand. The nurse is not seeking feedback.

The 32-year-old patient in a mental health unit discusses his personal thoughts and feelings with the nurse. The nurse is maintaining the circle of confidentiality by reporting this information to which individuals? Select all that apply.
A)
The patient’s physician
B)
The patient’s family
C)
The nurse from the oncoming shift
D)
The unit’s mental health technicians
E)
The patient’s closest friend
Ans:
A, C, D

Feedback:

Unless the patient has specifically given permission to provide information to family and friends, this information should remain among individuals on the healthcare team that are directly involved with care of the patient.

10.

The nurse is talking with a patient who is thinking about obtaining a second opinion regarding the surgeon’s recommendation for surgery. Which response by the nurse is considered an advocacy response?
A)
“You have one of the best surgeons in the area. I think it would be a waste of time to seek another opinion.”
B)
“Your surgeon has always given you the best care and is genuinely concerned with your health.”
C)
“You can do what you want, but I would get the surgery done as soon as possible.”
D)
“Let us know if we can answer any further questions after you obtain your second opinion.”
Ans:
D

Feedback:

Offering support and further assistance, as well as information, represents an advocacy response. Stating the surgeon is one of the best or advising to get the surgery done as soon as possible are authoritarian responses. Telling the patient that the surgeon has always cared for them well is using a guilt response.

11.

The mother of a toddler is trying to decide 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?
A)
Authoritarian
B)
Guilt inducement
C)
Advocacy
D)
Dictatorial
Ans:
B

Feedback:

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 patient should do based on the healthcare professional’s professional opinion. An advocacy response supplies the patient with information to make the decision.

12.

When the preoperative patient tells the nurse that he cannot sleep because he keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is
A)
“Sounds as if your surgery is a pretty scary procedure.”
B)
“You have a great surgeon. You have nothing to worry about.”
C)
“You shouldn’t be nervous. We perform this procedure every day.”
D)
“The thought of having surgery is keeping you awake.”
Ans:
D

Feedback:

Reflection means identifying the main emotional themes.

13.

In the provision of care and the establishment of the therapeutic relationship, the nurse must first
A)
Understand the patient’s response
B)
Be aware of one’s own personality
C)
Avoid labeling patients
D)
Treat the patient with dignity
Ans:
B

Feedback:

Before a nurse can communicate therapeutically, a comfortable sense of self, such as being aware of one’s own personality, values, cultural background, and style of communication, is necessary.

14.

Care provided to a patient following surgery and until discharge represents which phase of the helping relationship?
A)
Orientation phase
B)
Working phase
C)
Termination phase
D)
Evaluation phase
Ans:
B

Feedback:

During the working phase, the nurse and patient explore and develop solutions that are enacted and evaluated in subsequent interactions.

15.

When caring for a psychiatric patient, a formal contract is made with the patient during which phase of the nurse-patient relationship?
A)
Intimate phase
B)
Orientation phase
C)
Working phase
D)
Termination phase
Ans:
B

Feedback:

In the psychiatric setting, 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 used as a therapeutic tool to help a patient develop more insight and control over his or her own behavior.

16.

A nurse enters the patient’s room and introduces himself stating, “Hello, Mr. Alonso. My name is Anthony Bader. I will be your registered nurse today. I will be providing your nursing care and I will be with you until 3:30 PM. If you need anything, please call me on my phone or put your light on.” He then gives the patient a printed card with this information. In the helping relationship, what does this represent?
A)
Intimate phase
B)
Orientation phase
C)
Working phase
D)
Termination phase
Ans:
B

Feedback:

The orientation phase consists of introductions and an agreement between the nurse and the patient about their mutual roles and responsibilities.

17.

When caring for a patient, nursing care will be most effective when the nurse-patient interactions are focused on which of the following circumstances?
A)
Goal achievement
B)
Compatible realities
C)
Common understanding
D)
Sharing values
Ans:
C

Feedback:

The nursepatient interaction is most productive when communication is aimed toward a common understanding. Goal achievement is difficult to attain if there is not a common understanding between the nurse and patient.

18.

When communicating with patients, nurses need to be very careful in their approach. This is particularly true when communicating using
A)
Written material
B)
Audiovisuals
C)
Demonstration
D)
Medical terminology
Ans:
D

Feedback:

Another filter is the particular language system into which the person is socialized. Nurses are socialized into healthcare or medical jargon. To effectively educate and communicate, the nurse should limit medical jargon.

19.

While communicating with a patient who is hearing impaired, the nurse must take into account that the impairment serves as a
A)
Handicap
B)
Filter
C)
Blocker
D)
Receptor
Ans:
B

Feedback:

Sight, hearing, touch, taste and smell are filters of the neurologic receptor system. Stimuli processed through these receptor systems enable the person to experience the outside world.

20.

A nurse touches the patient’s hand while discussing his diagnosis. This action is a(an)
A)
Dynamic process
B)
Translation
C)
Communication channel
D)
Auditory channel
Ans:
C

Feedback:

Communication channel is the carrier of the message; touch can be a channel.

21.

A nurse is interviewing a patient for the establishment of long-term care insurance. During the interview, the nurse asks questions regarding the patient’s past medical history. The nurse is the
A)
Sender
B)
Target
C)
Receiver
D)
Decoder
Ans:
A

Feedback:

A sender is a person or group with a purpose for the communication.

22.

You are caring for a patient who has had a cerebrovascular accident, with left hemiparesis and aphasia. The patient responds to your spoken words with garbled responses. The nurse determines that the patient has difficulty with message
A)
Encoding
B)
Feedback
C)
Decoding
D)
Channeling
Ans:
A

Feedback:

The patient who has suffered a cerebral vascular accident and has aphasia may understand the words spoken to him but may be unable to encode and send a message in return.

23.

The patient responds to the nurse’s questions by stating in a loud and abrupt tone, “Yes, I understand my diabetic diet and how to give my insulin.” What type of message has the patient sent to the nurse?
A)
Inconclusive
B)
Precise
C)
Clear
D)
Incongruent
Ans:
D

Feedback:

When the nonverbal meta-communication aspects of the message do not fit with the verbal message, the communication is considered incongruent.

24.

An elderly patient who has had a colostomy for over 10 years states, “I won’t need any teaching about colostomies. I understand how to change the bag and care for my colostomy, but I’m not sure how to best clean my stoma?” What does this statement indicate?
A)
An incongruent relationship
B)
A confused relationship
C)
A non-therapeutic relationship
D)
An evaluative relationship
Ans:
A

Feedback:

The patient’s two statements are incongruent with each other. This indicates the need for further education.

25.

A nurse communicating with a patient states, “I will be changing your dressing.” She is wearing sterile gloves and a mask. She is conveying a(an)
A)
Congruent relationship
B)
Incongruent relationship
C)
Non-therapeutic relationship
D)
Functional focus
Ans:
A

Feedback:

The communication and protective equipment conveys messages that are congruent.

26.

The term meta-communication is best defined as
A)
Congruent relationships in the spoken topics
B)
Documenting a conversation between the patient and nurse
C)
Contextual factors that impede communication patterns
D)
Interpersonal bridge between verbal and nonverbal communication
Ans:
D

Feedback:

Meta-communication is communication about the 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.

27.

When the nurse communicates with a newly admitted patient, the nurse must pay particular attention to nonverbal behaviors. The nurse considers which of the following as nonverbal communication?
A)
The patient’s accent
B)
The patient’s tone of voice
C)
The patient’s religious practices
D)
The patient’s ethnicity
Ans:
B

Feedback:

A person communicates by gestures, facial expressions, posture, space, appearance, body movement, touch, voice tone and volume, and rate of speech.

28.

When documenting patient care, the nurse understands that the most important reason for correct and accurate documentation is which of the following?
A)
Legal representation to care
B)
Conveyance of information
C)
Assisting in organization of care
D)
Noting the patient’s response to interventions
Ans:
B

Feedback:

Documentation of care in the patient’s record is most important for communicating with other healthcare team members that are involved in the care of the patient.

29.

Communication is the
A)
Essence of nursing
B)
Heart of nursing
C)
Core of nursing
D)
Integral part of nursing
Ans:
B

Feedback:

Communication is at the heart of nursing.

30.

In order to provide effective nursing care, the nurse should engage in what type of communication with the patient and significant others?
A)
Interpersonal communication
B)
Intrapersonal communication
C)
Meta-communication
D)
Therapeutic communication
Ans:
D

Feedback:

Therapeutic communication facilitates interactions focused on the patient and the patient’s concerns.

31.

During an annual performance review with an employee, the nurse manager does not maintain eye contact and seems concerned about the time and the next appointment. This use of communication is considered
A)
Consistent
B)
Verbal
C)
Nonverbal
D)
Clarifying
Ans:
C

Feedback:

Listening can be hampered by the listener’s lack of interest in the topic, premature interpretation of the message, or preoccupation with practice. The nonverbal cues that accompany the message are essential aspects of verbal communication.