Homework Lance
1. The briefest explanation of therapeutic communication is that it:
a.
has a specific intent or purpose.
b.
is the only form of professional communication.
c.
should never be used in a social setting.
d.
requires no special skills, just a willingness to listen.
ANS: A
Therapeutic communication is a style of conversation between the nurse and the patient in which there is a specific purpose or intent.
DIF: Cognitive Level: Knowledge REF: 88 OBJ: 5
TOP: Therapeutic Communication KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
2. The nurse is careful in the use of medical jargon while talking with an older adult patient because the use of medical jargon might become a(n):
a.
opportunity to instruct the patient.
b.
effective abbreviated communication shortcut.
c.
indicator of formal communication.
d.
communication barrier.
ANS: D
The use of jargon can become a barrier because the patient may not understand and would be unwilling to disclose ignorance of terms. Habitual use makes health professionals less sensitive to persons who may not be familiar with the terms.
DIF: Cognitive Level: Comprehension REF: 89 OBJ: 1
TOP: Communication Barrier KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
3. The nurse uses superficial social conversation to initiate communication because this type of exchange:
a.
lets the patient know that he or she is considered to be a person, not just a patient.
b.
encourages sharing of intimate details.
c.
establishes the nurse’s role as a health care provider.
d.
blocks more meaningful therapeutic communication.
ANS: A
Social conversations establish that the nurse considers the patient a person in his or her own right. Such conversation is valuable for the nurse to discover information about the patient as a person and for the patient to discover information about the nurse as a person.
DIF: Cognitive Level: Comprehension REF: 90 OBJ: 1 | 4
TOP: Social Conversation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
4. The nurse communicating with an older adult who has a hearing impairment will improve reception by speaking:
a.
in a higher tone, standing directly in front of the patient.
b.
more loudly from several feet away.
c.
normally with exaggerated hand gestures.
d.
in a low tone, bending close to the patient.
ANS: D
Speaking in a low tone and bending near the patient is a more effective way to communicate with the hearing-impaired.
DIF: Cognitive Level: Application REF: 91 OBJ: 1
TOP: Communicating with the Hearing-Impaired
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
5. Seeing a patient with his head in his arms resting on the over-the-bed table, the nurse steps into the room and asks if the patient feels ill. The patient, without raising his head, says, “I’m fine.” The nurse should:
a.
sit down next to the bed and say, “You don’t act fine.”
b.
pat him on the shoulder and continue on rounds.
c.
say, from the doorway, “If you need anything, just call me.”
d.
assist the patient to sit up and say, “Now, that’s much better, isn’t it?”
ANS: A
Reading the body language that says “I’m not fine,” the nurse should enter the room and be seated to demonstrate willingness to listen.
DIF: Cognitive Level: Application REF: 91 OBJ: 3
TOP: Body Language KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
6. When approaching an older adult to insert a catheter, the nurse should:
a.
touch the patient and say, “I need to insert this catheter.”
b.
approach the bed, turn back the cover, and announce, “The doctor wants a urine specimen.”
c.
open catheter tray at bedside, turn back the cover, and say, “Is it okay to put a tube in your bladder?”
d.
introduce yourself at the door and ask, “May I insert this catheter for a urine specimen?”
ANS: D
Speaking to the patient from a public space and requesting permission to do a procedure is the best approach. All other options indicate, by the nurse’s nonverbal communication, that permission is not really required before insertion.
DIF: Cognitive Level: Application REF: 91 OBJ: 3
TOP: Invading Space KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
7. The nurse is aware that for a patient with receptive aphasia, the best method of communication would be the use of:
a.
a notepad.
b.
speaking slowly.
c.
worded flash cards.
d.
gestures.
ANS: D
Gestures and/or symbols are helpful for persons with receptive aphasia because they cannot recognize the spoken or written word.
DIF: Cognitive Level: Analysis REF: 91 OBJ: 3
TOP: Use of Gestures KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
8. The white female nurse is concerned that the 80-year-old African American male patient is not being truthful with her because of his:
a.
lack of eye contact.
b.
smiling facial expression.
c.
tone of voice.
d.
body language.
ANS: A
The nurse needs to be aware that African Americans, particularly older adults, limit eye contact as a sign of respect.
DIF: Cognitive Level: Knowledge REF: 92 OBJ: 6
TOP: Eye Contact KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
9. When asked about the severity of pain, the 93-year-old patient does not answer right away. The nurse should:
a.
ask rapid questions: “Is it better? Is it worse than yesterday? Is it worse than this morning?”
b.
repeat the question in a louder voice.
c.
say, “You must be feeling better because you’re not complaining.”
d.
keep eye contact and wait for the answer.
ANS: D
Patient empathetic listening is the key to maintaining good communication with the older adult.
DIF: Cognitive Level: Application REF: 92 OBJ: 2
TOP: Active Listening KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
10. When the nurse answers the call light after a delay of 5 minutes, the angry patient says, “You made me wait an hour. I’m in pain and no one’s willing to help me.” The nurse’s best response would be:
a.
“It’s only been 5 minutes. What do you want?”
b.
“Well, I’m here now. What is your problem?”
c.
“I know it must have seemed like an hour. I’ll bring your medication.”
d.
“I was attending to another patient who’s really ill. I’ll help you now.”
ANS: C
Many older adults have an altered sense of time. Waiting makes them more anxious. Responding in a defensive or grudging manner is not effective for the nurse-patient relationship.
DIF: Cognitive Level: Application REF: 93 OBJ: 4
TOP: Timing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
11. The 93-year-old woman with chronic back pain is found crying. When the nurse approaches, the patient says, “I know you can’t do anything more, but I hurt so bad.” The nurse’s best intervention would be to:
a.
bring pain medication when it is time for it.
b.
assure the patient that the pain medication will take effect soon.
c.
touch the patient’s shoulder and sit quietly without speaking.
d.
distract the patient by offering a sip of water.
ANS: C
Use of empathetic touch is a message of comfort. The other options do not address the patient’s distress relative to unrelieved pain.
DIF: Cognitive Level: Analysis REF: 93 OBJ: 3
TOP: Silence KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
12. When entering the room of a new 85-year-old female patient to complete the admission process, the nurse should initiate the conversation by saying:
a.
“Good morning, Mary. We need to get some questions answered.”
b.
“Welcome to 4B, Mrs. Miller. I’d like to get some additional information, if I may.”
c.
“Hello, sweetie. I’ll bet you thought all the admission stuff was finished, didn’t you?”
d.
“I need to finish the admission. What is your name?”
ANS: B
Using a formal address is a respectful way to start a conversation with a new patient. If the patient prefers to be called something else, he or she can inform the nurse of that desire.
DIF: Cognitive Level: Comprehension REF: 94 OBJ: 1
TOP: Respect KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
13. The nurse informing a patient about an upcoming diagnostic procedure could best relate the information by saying:
a.
“Mr. Brown, your leg is to be x-rayed in the x-ray department in an hour.”
b.
“X-ray is coming to get you for an AP and lateral of your chest.”
c.
“You can’t eat anything after supper because of some lab work.”
d.
“Mrs. Smith, the OR has notified us that they’re running behind.”
ANS: A
Clear, concise information in words that the patient can understand is the most effective method for providing information.
DIF: Cognitive Level: Application REF: 97 OBJ: 4
TOP: Informing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
14. The nurse is aware that the overuse of direct questions can:
a.
get a lot of information quickly.
b.
help the patients organize their thoughts.
c.
get minimum response answers of “yes” and “no.”
d.
make patients think that they are contributing to their health care.
ANS: C
The diminished, overwhelmed patient will give minimal answers to direct questions if the technique is overused. The technique is best used to obtain factual information.
DIF: Cognitive Level: Application REF: 97 OBJ: 4
TOP: Direct Questions KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
15. The patient denies smoking, although the smell of tobacco is strong in his hospital room. The nurse confronts the patient most effectively by saying:
a.
“Don’t bother to lie to me. I know you’ve been smoking.”
b.
“It is very dangerous to smoke in bed.”
c.
“The hospital has policies against smoking.”
d.
“I can smell the tobacco, and I see your lighter on the bedside table.”
ANS: D
Identifying evidence in a nonaccusatory manner establishes the point of discrepancy. Belittling the patient or quoting policy is not confrontation.
DIF: Cognitive Level: Analysis REF: 97 OBJ: 4
TOP: Confrontation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
16. When inquiring about the degree of pain, the nurse could best support the patient by asking:
a.
“Does your stomach hurt now?”
b.
“How would you describe your pain?”
c.
“When the pain occurs, does the medicine help?”
d.
“Do you use more than one pain remedy?”
ANS: B
Open-ended questions allow the patient to give more elaborate answers.
DIF: Cognitive Level: Application REF: 97 OBJ: 4
TOP: Open-Ended Questions KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
17. The patient says, “When I came to the hospital yesterday, everything got confused.” The nurse’s best response would be:
a.
“What happened?”
b.
“Yes, hospital admissions can be confusing.”
c.
“Are you confused now?”
d.
“We really try to make admissions less stressful.”
ANS: A
Clarifying an unclear statement with the use of an open-ended query is helpful to providing better communication.
DIF: Cognitive Level: Application REF: 97 OBJ: 4
TOP: Clarification KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
18. The nurse reminds the CNAs that only about ___% of communication is transmitted by way of verbal communication.
a.
7
b.
18
c.
22
d.
36
ANS: A
It is estimated that only about 7% of communication is transmitted by verbal methods. Nonverbal communication is the most effective method of communicating.
DIF: Cognitive Level: Knowledge REF: 89 OBJ: 3
TOP: Nonverbal Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
19. The caring nurse will use empathetic listening in order to:
a.
encourage the patient to divulge information.
b.
gain time to pose another question to the patient.
c.
indicate the conversation has come to a close.
d.
interpret what the patient has said.
ANS: D
Empathetic listening is a skill that helps the nurse interpret what the patient is saying. A nurse has not really listened until the nurse has understood what was intended by the speaker.
DIF: Cognitive Level: Application REF: 94 OBJ: 2
TOP: Empathetic Listening KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
20. When using an interpreter to speak with an 84-year-old Chinese woman, the nurse will focus on:
a.
the patient, not the interpreter.
b.
encouraging the interpreter to paraphrase.
c.
limiting questions from the patient.
d.
listening to the words, not emotional tone.
ANS: A
The nurse using an interpreter should focus on the patient and the patient’s emotional tones, not the interpreter. The patient should be encouraged to ask questions. The interpreter should not paraphrase.
DIF: Cognitive Level: Comprehension REF: 96 OBJ: 6
TOP: Using an Interpreter KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
21. The nurse must tell a 94-year-old resident of a nursing home that his wife has fallen and has been hospitalized with a broken hip. In planning the delivery of this distressing news, the nurse should:
a.
hurry through the conversation to spare the resident.
b.
conserve time by delaying plans for follow-up.
c.
use social conversation before the delivery of the information.
d.
gather all pertinent information that is accurate.
ANS: D
The nurse should gather all the pertinent information to address the resident’s questions. The message should be direct and simple, and time should be allowed for the resident to react. Follow-up plans should be considered.
DIF: Cognitive Level: Comprehension REF: 98 OBJ: 4
TOP: Delivering Bad News KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
22. The area within 18 inches of a person is known as _____ space.
a.
public
b.
social
c.
personal
d.
intimate
ANS: D
The space within 18 inches of the body is considered intimate space.
DIF: Cognitive Level: Application REF: 91 OBJ: 1
TOP: Proxemics KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
23. The area between 18 inches and 4 feet of a person is known as _____ space.
a.
public
b.
social
c.
personal
d.
intimate
ANS: C
A distance of 18 inches to 4 feet is considered personal space.
DIF: Cognitive Level: Application REF: 91 OBJ: 1
TOP: Proxemics KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
24. The area between 4 and 12 feet of a person is known as _____ space.
a.
public
b.
social
c.
personal
d.
intimate
ANS: B
Between 4 and 12 feet is considered social space.
DIF: Cognitive Level: Application REF: 91 OBJ: 1
TOP: Proxemics KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
25. The area 12 feet from a person and beyond is known as _____ space.
a.
public
b.
social
c.
personal
d.
intimate
ANS: A
Public space is when strangers are 12 feet or more away from a person.
DIF: Cognitive Level: Application REF: 91 OBJ: 1
TOP: Proxemics KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
MULTIPLE RESPONSE
1. It is important to remember that older adults of today differ from young adults in regard to __________. (Select all that apply)
a.
experience with electronic tools of communication
b.
attitude about lifestyles
c.
value of money
d.
methods of communication
e.
perceptions of gender roles
ANS: B, C, D, E
Older adults today do have knowledge of electronic tools of communication.
DIF: Cognitive Level: Knowledge REF: 88 OBJ: 1
TOP: Age Bracket Differences KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
2. The nurse is aware that successful communication is dependent on __________. (Select all that apply.)
a.
the need to share information with someone else
b.
empathetic listening
c.
assessing or correcting communication barriers
d.
using perfect grammar
e.
use of a variety of communication skills
ANS: A, B, C, E
Perfect grammar is not essential to successful communication.
DIF: Cognitive Level: Comprehension REF: 88 OBJ: 1
TOP: Successful Communication KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
3. The nurse is aware that selection of words and phraseology is significant for effective communication. The nurse should base the communication approach on the patient’s __________. (Select all that apply.)
a.
culture
b.
ethnicity
c.
income level
d.
perspective
e.
level of education
ANS: A, B, D, E
Income level is not a consideration in effective communication.
DIF: Cognitive Level: Comprehension REF: 88 OBJ: 1
TOP: Communication with Older Adults KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
4. The nurse is sensitive to the use of nonverbal communication from patients, which includes the interpretation of __________. (Select all that apply.)
a.
choice of words
b.
voice tone
c.
body language
d.
gestures
e.
facial expressions
ANS: B, C, D, E
Choice of words indicates verbal communication. All other options play a part in nonverbal communication.
DIF: Cognitive Level: Comprehension REF: 90-91 OBJ: 3
TOP: Nonverbal Communication KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
5. The nurse uses touch as a form of communication to convey __________. (Select all that apply.)
a.
affection
b.
understanding
c.
concern
d.
empathy
e.
acknowledgment
ANS: A, B, C, D, E
The application of touch conveys all the options.
DIF: Cognitive Level: Comprehension REF: 93 OBJ: 3
TOP: Touch KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
6. Which of the following represent “elderspeak” from the examples below? (Select all that apply.)
a.
“Ok, honey, let’s get a bath now.”
b.
“Oh, dear! We better get you a clean diaper.”
c.
“Today is Tuesday, Mr. Brown. It’s your dialysis day.”
d.
“My gracious, Mary! What in the world are you doing out here in the hall?”
e.
“You naughty girl! Just look at the front of your dress.”
ANS: A, B, D, E
Using baby talk and endearing names is demeaning and is a subtle form of abuse. Giving direct information to the patient—treating the patient as an adult—is a respectful type of dialogue.
DIF: Cognitive Level: Comprehension REF: 94 OBJ: 1
TOP: Elderspeak KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
7. The nurse is aware that there are many communication barriers when conversing with the older adult, which includes __________. (Select all that apply.)
a.
hearing impairment
b.
language differences
c.
dementia
d.
pain
e.
aphasia
ANS: A, B, C, D
Aphagia is the lack of ability to swallow, which affects a person’s ability to speak. All other options are communication barriers.
DIF: Cognitive Level: Knowledge REF: 95 OBJ: 1
TOP: Language Barriers KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
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