Caring in Nursing Practice

1. The best way for a new graduate to demonstrate caring behavior towards the client is by:

1.
Seeking assistance before attempting a new procedure
2.
Attempting to do new treatments as quickly as possible
3.
Informing the client when performing a treatment for the first time on an actual client
4.
Avoiding situations with clients that may be uncomfortable for either the nurse or the client

ANS: 1

Acquiring assistance from a staff member before performing a new procedure demonstrates caring behavior toward a client. If the graduate nurse has the assistance of someone who is skilled in the procedure, the client will be less likely to experience anxiety and the procedure will likely be completed quicker.

Performing new treatments as quickly as possible may convey a message of the nurse not having time for the client, or not valuing the client as a person.

Being honest is important, but informing clients of a lack of experience may only increase the client’s level of anxiety.

Avoiding uncomfortable situations does not demonstrate caring behavior toward the client. In contrast, it demonstrates detachment and a lack of commitment on the part of the nurse.

DIF: C REF: 98 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

2. The nurse knows that according to Benner, caring is defined as a:

1.
New consciousness and moral idea
2.
Nurturing way of relating to a valued other
3.
Person, event, project, or thing that matters to a person
4.
Central, unifying, and dominant domain necessary for health and survival

ANS: 3

According to Benner, caring means that persons, events, projects, and things matter to people.

Watson defines caring as a new consciousness and moral idea.

Swanson defines caring as a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.

According to Leininger, caring is the central, unifying, and dominant domain distinguishing nursing from other health disciplines and is necessary for the health and survival of all individuals.

DIF: A REF: 96 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

3. Which one of the following nursing activities is an example of Swanson’s “enabling” in the caring process?

1.
Staying with the client before surgery
2.
Performing a urinary catheterization skillfully
3.
Assessing the client’s health history
4.
Teaching the client how to inject fast-acting insulin

ANS: 4

According to Swanson, enabling is defined as facilitating the other’s passage through life transitions (e.g., birth, death) and unfamiliar events (e.g., self-injection of insulin).

Staying with the client before surgery would be an example of Swanson’s “being with” in the caring process.

Performing a catheterization skillfully would be an example of Swanson’s “doing for” in the caring process.

Assessing the client’s health history would be an example of Swanson’s “knowing” in the caring process.

DIF: A REF: 99 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

4. Riemen’s study of nurses’ caring behaviors (1986) found which one of the following as a similarity between male and female clients’ perceptions of nursing caring behaviors?

1.
Physical presence
2.
Promotion of autonomy
3.
Knowledge of injection technique
4.
Speed in the completion of treatment

ANS: 1

According to Riemen, the nurse being physically present with the client provides a perception of caring, which is shared by both female and male clients.

Promotion of autonomy was not found to be a perception of caring behavior by female and male clients in Riemen’s study. Mayer found promotion of autonomy to be identified as nurse caring behavior as perceived by families of clients with cancer.

Mayer found knowledge of injection technique to be perceived as a nursing caring behavior by cancer clients.

Speed of treatment completion was not perceived as a nursing caring behavior.

DIF: A OBJ: Knowledge TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

5. The nurse should realize that the most important aspect of knowing the client involves:

1.
Establishing a relationship
2.
Gathering assessment data
3.
Treating discomforts quickly
4.
Assuming the client’s emotional needs

ANS: 1

Nurses must focus on building a relationship that allows them to learn what is important to their clients.

Gathering assessment data is not the most important aspect of knowing a client in relation to caring. Data gathering does not ensure the nurse will be able to determine the client’s perceptions and unique expectations. Success in knowing a client lies in the relationship that is established.

Treating discomforts quickly is not the most important aspect of knowing a client.

If a nurse is assuming the emotional needs of a client, then the nurse most likely lacks knowledge of the client. It is more important to have a relationship in which the nurse can verify which emotional needs the client is experiencing. Knowing who clients are helps the nurse to select those caring approaches that are most appropriate to the client’s needs.

DIF: C REF: 97-98 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

6. The nurse can best demonstrate caring behavior by:

1.
Updates the family about the client’s condition
2.
Asks to address the client by the client’s first name
3.
Closes the door and covers the client during morning care
4.
Shares with the client’s roommate that she is scheduled for tests

ANS: 3

When the nurse closes the door and covers the client during a bath, the nurse is displaying behaviors that make the client feel valued as a human being. The nurse is attending to the client and is preserving the client’s dignity.

Keeping family members informed is perceived as a caring behavior by family; however, the nurse must first have the client’s permission to do so.

Calling the client by his or her first name may not demonstrate caring behavior because a caring relationship has not yet been established. The nurse would be assuming it is acceptable to the client to call him or her by the first name. The nurse should enter the relationship with respect for the client and avoid making assumptions.

Sharing personal information about the client with the roommate would be a breech of confidentiality.

DIF: A REF: 99-100 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

7. To best improve the bathing care provided by a particular staff member, the nurse manager should:

1.
Tell the staff member how to correctly give baths to clients
2.
Provide the staff member with good resources to read on bathing clients
3.
Ask another staff member to provide the unit’s bathing care in the afternoon
4.
Assist and observe the staff member in the bathing care of a client on the unit

ANS: 4

Persons who do not experience care in their lives often find it difficult to act in caring ways. The nurse manager who demonstrates a bath acts as a role model and conveys the value of caring. The staff member may also feel more valued because the nurse manager took the time to be with the staff member individually.

Telling the staff member how to give baths is less apt to change behavior. The staff member needs to see why it is important before they are likely to be motivated to change his or her behavior.

Providing staff members with resources to read does not ensure that the staff members will read them or change their behavior.

Asking another staff member to provide special skin care does not address the problem of poor hygienic care by the staff member.

DIF: C REF: 98 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

8. The nurse knows that a key element in Leininger’s theory of caring is that it includes:

1.
Five categories of caring
2.
Connectedness with others
3.
Transcultural perspectives
4.
Spiritual dimensions and healing

ANS: 3

A key element of Leininger’s theory is transcultural perspectives. Leininger stresses that even though human caring is a universal phenomenon, the expressions, processes, and patterns of caring vary among cultures.

Swanson’s theory describes caring as consisting of five categories or processes.

Being connected with others is a key element of Benner and Wrubel’s theory.

A key element in Watson’s theory is spiritual dimensions and healing.

DIF: A REF: 96-97 OBJ: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

9. Caring enables a nurse to know the client and thereby focus on identifying the client’s specific needs. This ability is most typically impacted by a nurse’s:

1.
Assessment skills
2.
Sense of compassion
3.
Clinical experience
4.
Communication proficiency

ANS: 3

As nurses acquire more experience, they typically learn that caring helps them to focus on the clients for whom they care. Caring facilitates a nurse’s ability to know a client, allowing the nurse to recognize a client’s problems and to find and implement individualized solutions.

While assessment skills aid a nurse’s ability to identify client needs, they do not have the greatest impact on the development of caring as a nursing characteristic.

Although compassion is a vital component of a caring nurse’s personality, it does not have the greatest impact on the development of caring as a nursing characteristic.

While effective, proficient nurse-client communication is a vital nursing skill, it does not have the greatest impact on the development of caring as a nursing characteristic.

DIF: C REF: 99 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

10. A client with chronic respiratory problems tells the nurse, “I haven’t felt this good in a long time.” The nurse realizes that the statement most reflects the client’s:

1.
Willingness to share his feelings
2.
Acceptance of his physical limitations
3.
Personal definition of his individual health
4.
Acknowledgment of his chronic health problems

ANS: 3

Health is a state of being that people define in relation to their own values, personality, and lifestyle.

While this is an example of the client’s willingness to share his feelings, its primary significance is its expression of his personal definition of health as it relates to himself.

Although the statement does allude to the client’s impaired physical health, its primary significance is its expression of his personal definition of health as it relates to himself.

While the statement does allude to the client’s impaired physical health, its primary significance is its expression of his personal definition of health as it relates to himself.

DIF: C REF: 96 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance/Health and Wellness

11. Which of the following statement’s best expresses the client’s definition of personal illness?

1.
“I came to the emergency department when the pain got too bad to ignore.”
2.
“I have arthritis, but I continue to enjoy knitting, embroidery and other needle work.”
3.
“Sometimes my bad knee keeps me from the hiking, but I do it as much as I can.”
4.
“It will be a terrible blow when my heart condition keeps me stuck in the house.”

ANS: 1

Illness is the experience of loss or dysfunction as perceived by the client. Although the client acknowledged an illness in each of the other responses, the statements do not reflect a sense that the client acknowledges being ill.

DIF: C REF: 96 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance/Health and Wellness

12. Which of the following statements reflects the best understanding of cultural caring provided by professional nurses?

1.
“Nurses must be open to learning the culture of our clients.”
2.
“Nurses need to attend to clients in a culturally sensitive manner.”
3.
“I care for my clients in ways that respect their culture and beliefs.”
4.
“Culture caring means allowing the client the freedom to be himself.”

ANS: 3

Nurses must provide caring behaviors based on clients’ cultural values and beliefs. While the need for human caring is universal, its application is based on cultural norms. Although the other statements are true, they do not address the means by which a nurse is culturally caring.

DIF: C REF: 97 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

13. When facilities strive to improve client satisfaction, the area of primary focus should be:

1.
Holistic client care
2.
Caring nursing staff
3.
Expert care providers
4.
State-of-the-art technology

ANS: 2

As institutions look to improve client satisfaction, creating an environment of caring is a necessary and worthwhile goal. Clients’ satisfaction with nursing care is an important factor in their decision to return to a hospital. Although the other options are hallmarks of quality client care, research has shown that client satisfaction is primarily influenced by the client’s perception of a caring nursing staff.

DIF: C REF: 99 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

14. The nurse observes a client scheduled for an invasive procedure crying while discussing the procedure with a family member. Which of the following therapeutic nursing interventions would be the most caring?

1.
Arranging for the client’s clergy to visit
2.
Inquiring, “Why is your sister crying?”
3.
Providing a detailed explanation of the procedure
4.
Offering to “sit and talk” if the client has any questions

ANS: 4

Knowing who clients are helps you select caring approaches that are most appropriate to the clients’ needs. For that reason, focus on building a relationship that allows you to learn what is important to your clients.

While arranging for clergy to visit may be comforting to some clients, the nurse must first ‘know’ the client to determine if it would be appropriate and then ask the client if they wish clergy to visit.

While asking someone why the client is crying may get to the root of the crying, it does not aid directly in the nurse-client relationship that will help in the development of a caring relationship built on the nurse ‘knowing’ the client.

While offering to answer questions may help minimize the client’s fear, it will be effective only after the nurse ‘knows’ the client well enough to determine that the crying is a result of an insufficient understanding of the proposed procedure.

DIF: C REF: 101 OBJ: Analysis

TOP: Nursing Process: Assessment/Planning

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

15. A client has confided to the nurse that she would prefer hospice care to receiving further radical treatment for terminal pancreatic cancer. The nurse observes that the client fails to share her wishes with her family during a discussion regarding future treatment plans. Ethically, the nurse should first:

1.
Tell the family of the client’s expressed wishes
2.
Privately ask the client if her wishes have changed
3.
Inform the client’s health care provider of her wishes
4.
Share with the client the importance of expressing her wishes

ANS: 2

In health care settings, clients and families are often on unequal footing with professionals because of the client’s illness, lack of information, regression caused by pain and suffering, and unfamiliar circumstances. An ethic of care places the nurse as the client’s advocate, solving ethical dilemmas by attending to relationships and by giving priority to each client’s unique personhood. Initially the nurse must clarify the client’s wishes.

The nurse may evidentially be a part of a discussion between client and family, but it is not the initial action ethically required of the nurse as the client’s advocate.

The nurse may intervene between the client and health care provider, but only after discussing the situation with the client and receiving her permission to do so.

If the client reaffirms her previously stated wishes, then it would be appropriate for the nurse to discuss the importance of stating those wishes to the family.

DIF: C REF: 100 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

16. When the nurse offers to “just sit here with you” after a particularly painful procedure, a homeless client asks, “Why would you want to do that?” The nurse recognizes that the client most likely:

1.
Prefers to be alone at this time
2.
Does not have a need for companionship
3.
Perceived the offer as being inappropriate
4.
Finds it difficult to understand the nurse’s concern

ANS: 4

Persons who do not experience care in their lives often find it difficult to accept or understand acts of caring or to act in a caring manner. Although the other options may be true, the nurse should first recognize that the client may be lacking in examples of caring in his own life and so finds it difficult to understand why someone else would be caring.

DIF: C REF: 96 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

17. A client who is re-learning to walk asks the nurse, “to come with me today to physical therapy.” The nurse realizes that the client is most likely expressing:

1.
A need for emotional support
2.
A need for familiar companionship
3.
An appreciation of the nurse’s caring
4.
An interest in validating her progress

ANS: 3

Providing presence is a person-to-person encounter conveying a closeness and a sense of caring. This type of presence is something the nurse offers to the client with the purpose of achieving some goal, such as support, comfort, or encouragement, to diminish the intensity of unwanted feelings or for reassurance. If clients accept the nurse, they will invite him or her to see, share, and touch their vulnerability and suffering. Although the other options may be true, the client will not likely seek out the nurse for emotional comfort if there is not a sense of presence between them.

DIF: C REF: 102 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

18. Which of the following client reactions reflects the greatest positive response to the nurse’s use of caring touch in the form of a backrub?

1.
The nurse observes the client smiling.
2.
The client falls asleep shortly after the backrub.
3.
The nurse feels the client’s back muscles relaxing.
4.
The client tells his wife that, “the nurse is so nice.”

ANS: 3

Caring touch is a form of nonverbal communication that successfully influences a client’s comfort and security, enhances self-esteem, and improves reality orientation.

While the other options may reflect a positive response, the presence of physical signs of relaxation would be a greater indicator of a positive response to the nurse’s caring touch.

DIF: C REF: 101 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

19. What is the single greatest factor that contributes to the struggle of today’s nurses to “know” the client?

1.
Nursing shortage
2.
High client acuity
3.
Shorter hospital stays
4.
Increasing client loads

ANS: 4

Nurses have increasingly less time to spend with clients, making it much harder to know who they are. Nursing shortages, high client acuity, and shorter hospital stays are all contributing factors to why nurses have increasing client loads and less time with the patient.

DIF: C REF: 103 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

20. Which of the following nurse-family interactions is most reflective of caring for the family?

1.
Offering to arrange for a sleep chair for the family’s use
2.
Notifying the family that the client has returned from surgery
3.
Telling the family when the client’s surgeon will be on the unit
4.
Always being available to spend time answering the family’s questions

ANS: 3

Ensuring the client’s well-being and helping the family to be active participants are critical interactions for family members. Making it possible for the family to be present when the health care provider visits with the client allows the family to play a more active role in the client’s care and treatment. While the other options show caring, they are not the most valued examples because they do not directly impact family participation in the client’s care or treatment.

DIF: C REF: 103 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

21. With which of the following interventions does the nurse best reflect caring by maintaining belief in a client?

1.
Offering a client with cancer pain medication before a family visit
2.
Explaining to a client what to expect during a bone marrow aspiration
3.
Arranging for a burn client to talk with others who survived similar burns
4.
Explaining to a client that he may select from a variety of entrees for dinner

ANS: 3

Maintaining belief is sustaining faith in the client’s ability to successfully traverse the situation and have a meaningful life. Offering a client with cancer pain medication before a family visit is an example of doing for others what they cannot do for themselves. Explaining to a client what to expect during a bone marrow aspiration is an example of enabling that helps the client traverse the situation. Explaining to a client that he may select from a variety of entrees for dinner is an example of enabling that helps the client traverse the situation.

DIF: C REF: 102 OBJ: Analysis

TOP: Nursing Process: Planning/Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

22. Which of the following interventions made by a new graduate nurse reflects the best understanding of knowing her client?

1.
Asking the client, “What do you need to be more comfortable?”
2.
Offering the client’s family a sleeper chair for use in the client’s room
3.
Providing an extra blanket for a client who often complains of being cold
4.
Awakening the client for a phone call from her son who lives out of town

ANS: 1

Knowing the client is striving to understand an event as it has meaning in the life of the client.

While offering the client’s family a sleeper chair is an example of caring, it is not the best example of knowing the client because it centers on the physical needs of the family.

While providing an extra blanket to the client is an example of caring, it is not the best example of knowing the client.

Awakening the client for a phone call from her son who lives out of town would be an example of knowing the client only after the nurse truly had that insight; otherwise, it is an assumption and could interfere with actually knowing the client.

DIF: C REF: 99 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordinated Care

23. The nurse is caring for a homeless client who recently emigrated from China. The client has a language barrier, and the hospital has been unsuccessful in locating any relatives. The health care provider is considering the option of placing the client on a respirator to manage a severe respiratory tract problem. To be a caring advocate for this client, the nurse must first:

1.
Ask the hospital chaplain to arrange for appropriate religious support
2.
Be sure that the client receives the best available care for his condition
3.
Arrange for a Chinese interpreter to facilitate client-staff conversations
4.
Become familiar with the Chinese culture’s attitudes regarding life support

ANS: 4

To caringly advocate for this client, the nurse must first be familiar with the client’s cultural practices regarding life support. Arranging for religious support is appropriate only if the general culture indicates a reliance on religion and/or if the interpreter determined it was a client need.

While being sure the client receives the best available care for his condition is certainly the role of a nurse advocate, it is only after the nurse caringly “knows” the client that it can be determined what the best care really is for this client. Arranging for an interpreter will assist in “knowing” the client, which will aid in becoming the client’s advocate.

DIF: C REF: 97 OBJ: Analysis

TOP: Nursing Process: Planning/Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care