CH 20 COMMUNICATION

Question 1

1.
A group of nursing students is working together on a presentation for their clinical instructor. One student in the group participates by arguing and attempting to block each step of the process of this presentation. The student’s behavior is causing frustration for the others and slowing their progress. Which of the following best describes the role this individual student is playing in relationship to the group dynamics?
A)
Self-serving
B)
Task-oriented
C)
Maintenance
D)
Group-building

Answer 1

Ans:
A

Feedback:

The student’s behavior is best described as self-serving. Self-serving roles advance the needs of individual members at the group’s expense. Task-oriented roles focus on the work to be completed. Group-building or maintenance roles focus on the well-being of the people doing the work.

Question 2

2.
The nurse is caring for a client who speaks Chinese, and the nurse does not speak Chinese. An appropriate approach for communication with this client includes what?
A)
Using a caring voice and repeating messages frequently
B)
Speaking directly and loudly to the client
C)
Avoiding the use of gesture or play-acting
D)
Writing messages for the client and offering him a dictionary for translation.

Answer 2

Ans:
A

Feedback:

Approaches to use when a client speaks a different language include speaking slowly and distinctly, and avoiding loud voices. Use a caring voice, keeping messages simple, and repeat messages frequently. The use of a language dictionary by the nurse is appropriate, but writing messages and asking the client to translate is not an appropriate approach. Gestures, pictures, and play-acting help the client understand.

Question 3

3.
The daughter of an older adult female client has asked the nurse why a urine specimen was collected from her mother earlier that morning. How can the nurse best respond to the daughter’s query?
A)
“We want to test your mother’s urine to make sure she doesn’t have a urinary tract infection.”
B)
“Your mother’s doctor ordered a urine C&S to rule out a UTI.”
C)
“We want to do everything we can to get your mother healthy again.”
D)
“Sometimes sick urine can make the whole person sick, and this might be causing her fever.”

Answer 3

Ans:
A

Feedback:

In order to communicate effectively, the nurse needs to avoid the use of jargon or abbreviations (“C&S”) that are unfamiliar to those outside the health care system. At the same time, accuracy is important, and vague and “dumbed-down” answers (“we want to do everything we can,” “sick urine”) are inappropriate.

Question 4

4.
A nurse has drafted an SBAR communication before contacting the primary care provider of a client whose condition has worsened suddenly. How should the nurse best conclude this communication?
A)
Ask the care provider to come and assess the client.
B)
Provide the client’s most recent vital signs.
C)
Ask the care provider if he or she is familiar with this client.
D)
Provide the most likely diagnosis of the problem.

Answer 4

Ans:
A

Feedback:

The final phase of an SBAR communication involves making a recommendation. In the case of a client whose condition is worsening, this may entail recommending that the primary care provider come to assess the client. Asking the care provider if he or she is familiar with the client should be done early in the communication. Providing assessment data and possible diagnoses are addressed in the background and assessment sections of the tool.

Question 5

5.
The nurse has entered a client’s room and observes that the client is hunched over and appears to be breathing rapidly. What type of question should the nurse first implement in this interaction?
A)
A yes/no question
B)
A directing question
C)
An open-ended question
D)
A reflective question

Answer 5

Ans:
A

Feedback:

There are times when yes/no questions are appropriate. In this case, the nurse may want to ask, “Do you feel short of breath?” or something similar. Directing questions and reflective questions follow up on earlier communication. An open-ended question may elicit the necessary assessment data, but a yes/no question accomplishes this goal more directly.

Question 6

6.
The nurse has entered a client’s room after receiving a morning report. The nurse rapidly assessed the client’s airway, breathing, and circulation and greeted the client by saying “Good morning.” The client has made no reciprocal response to the nurse. How should the nurse best respond to the client’s silence?
A)
The nurse should ask appropriate questions to understand the reasons for the client’s silence.
B)
The nurse should apologize for bothering the client, perform necessary assessments efficiently and leave the room.
C)
The nurse should document the client’s withdrawal and diminished mood in the nurse’s notes.
D)
The nurse should ask the client if he feels afraid or angry.

Answer 6

Ans:
A

Feedback:

Silence can have many meanings, and the nurse should attempt to identify the meaning of the client’s silence in a tactful manner. Directly asking if the client is angry or fearful is likely presumptuous and may harm rapport. The nurse should not make assumptions around the client’s mood nor should the nurse cease to engage with the client.

Question 7

7.
A nurse touches a client’s hand to indicate caring and support. What channel of communication is the nurse using?
A)
Auditory
B)
Visual
C)
Olfactory
D)
Kinesthetic

Answer 7

Ans:
D

Feedback:

The nurse is using a kinesthetic channel of communication. The channel of communication is the medium the sender has selected to send the message. The channel might target any of the receiver’s senses. The channels are auditory (spoken words and cues), visual (sight, observations, and perceptions), and kinesthetic (touch).

Question 8

8.
A nurse is educating a home care client on how to administer a topical medication. The client is watching television while the nurse is talking. What might be the result of this interaction?
A)
The message will likely be misunderstood.
B)
The stimulus for communication is unclear.
C)
The receiver will accurately interpret the message.
D)
The communication will be reciprocal.

Answer 8

Ans:
A

Feedback:

Noise, which is a factor that distorts the quality of a message, can interfere with communication at any point in the process. If the client is watching television, it is likely that the message from the nurse will be misunderstood.

Question 9

9.
The family of a client in a burn unit asks the nurse for information. The nurse sits with the family and discusses their concerns. What type of communication is this?
A)
Intrapersonal
B)
Interpersonal
C)
Organizational
D)
Focused

Answer 9

Ans:
B

Feedback:

Interpersonal communication occurs among two or more people with a goal to exchange messages. Nurses spend most of their day communicating with clients, family members, and health care team members.

Question 10

10.
Which of the following is an example of nonverbal communication?
A)
A nurse says, “I am going to help you walk now.”
B)
A nurse presents information to a group of clients.
C)
A client’s face is contorted with pain.
D)
A client asks the nurse for a pain shot.

Answer 10

Ans:
C

Feedback:

Nonverbal communication is the transmission of information without the use of words. In this situation, the facial contortion is a nonverbal message of pain.

Question 11

11.
A nursing student caring for an unconscious client knows that communication is important even if the client does not respond. Which nonverbal action by the nursing student would communicate caring?
A)
Making constant eye contact with the client
B)
Waving to the client when entering the room
C)
Sighing frequently while providing care
D)
Holding the client’s hand while talking

Answer 11

Ans:
D

Feedback:

Tactile sense is a form of nonverbal communication and is viewed as one of the most effective nonverbal ways to express feelings of comfort.

Question 12

Tactile sense is a form of nonverbal communication and is viewed as one of the most effective nonverbal ways to express feelings of comfort.

12.
Which of the following statements is true of factors that influence communication?
A)
Nurses provide the same information to all clients, regardless of age.
B)
Men and women have similar communication styles.
C)
Culture and lifestyle influence the communication process.
D)
Distance from a client has little effect on a nurse’s message.

Answer 12

Ans:
C

Feedback:

Culture and lifestyle do influence the communication process; understanding a client’s culture assists nurses in understanding nonverbal communication and enables the nurse to deliver accurate care.

Question 13

13.
A nurse is sitting near a client while conducting a health history. The client keeps edging away from the nurse. What might this mean in terms of personal space?
A)
The nurse is outside the client’s personal space.
B)
The nurse is in the client’s personal space.
C)
The client does not like the nurse.
D)
The client has concerns about the questions.

Answer 13

Ans:
B

Feedback:

Each person has a sense of how much personal or private space is needed and what distance between individuals is optimum. It is best to take cues from the client; a client moving backward indicates discomfort with invasion of his or her personal space.

Question 14

14.
Why is communication important to the “assessing” step of the nursing process?
A)
The major focus of assessing is to gather information.
B)
Assessing is primarily focused on physical findings.
C)
Assessing involves only nonverbal cues.
D)
Written information is rarely used in assessment.

Answer 14

Ans:
A

Feedback:

The major focus of assessment is to gather information using both verbal and nonverbal communication forms. Nurses use the written word, the spoken word, and one-to-one communication with clients. Effective communication techniques, as well as observational skills, are used extensively during assessment.

Question 15

15.
A nurse uses the SBAR method to hand off the communication to the health care team. Which of the following might be listed under the “B” of the acronym?
A)
Vital signs
B)
Mental status
C)
Client request
D)
Further testing

Answer 15

Ans:
B

Feedback:

SBAR stands for Situation, Background, Assessment, and Recommendations, and provides a consistent method for hand-off communication that is clear, structured, and easy to use. Vital signs would fall under the category of situation; mental status: background; client request: assessment; further testing: recommendations.

Question 16

16.
What is the goal of the nurse in a helping relationship with a client?
A)
To provide hands-on physical care
B)
To ensure safety while caring for the client
C)
To assist the client to identify and achieve goals
D)
To facilitate the client’s interactions with others

Answer 16

Ans:
C

Feedback:

A helping relationship exists among people who provide and receive assistance in meeting human needs. When a nurse and a client are involved in a helping relationship, the nurse assists the client to identify and achieve goals that allow the client’s human needs to be met.

Question 17

17.
What action by the nurse will facilitate the helping relationship during the orientation phase?
A)
Providing assistance to meet activities of daily living
B)
Introducing oneself to the client by name
C)
Designing a specific teaching plan of care
D)
Preparing for termination of the relationship

Answer 17

Ans:
B

Feedback:

In the orientation phase of the helping relationship, the nurse and patient meet and learn to identify each other by name. It is especially important that the nurse introduce herself or himself to the patient during this phase.

Question 18

18.
Which of the nursing roles is primarily performed during the working phase of the helping relationship?
A)
Educator and counselor
B)
Provider of care
C)
Leader and manager
D)
Researcher

Answer 18

Ans:
A

Feedback:

The nursing roles of educator and counselor are primarily performed during the working phase of the helping relationship. This is where the nurse’s interpersonal skills are used to the fullest.

Question 19

19.
Which term describes a nurse who is sensitive to the client’s feelings, but remains objective enough to help the client achieve positive outcomes?
A)
Competent
B)
Caring
C)
Honest
D)
Empathic

Answer 19

Ans:
D

Feedback:

Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client’s feelings and problems, but remains objective enough to help the client work to attain positive outcomes.

Question 20

20.
What is the primary focus of communication during the nurse–client relationship?
A)
Time available to the nurse
B)
Nursing activity to be performed
C)
Client and client needs
D)
Environment of the client

Answer 20

Ans:
C

Feedback:

Communication in the nurse–client relationship should focus on the client and patient needs, not on the nurse or an activity in which the nurse is engaged.

Question 21

21.
Which of the following is an example of a closed-ended question or statement?
A)
“How did that make you feel?”
B)
“Did you take those drugs?”
C)
“What medications do you take at home?”
D)
“Describe the type of pain you have.”

Answer 21

Ans:
B

Feedback:

The closed-ended question or statement provides the receiver with limited choices of possible responses and might often be answered by one or two words, such as “yes” or “no.” When not used appropriately, closed-ended questions are a barrier to effective communication.

Question 22

22.
A client tells the nurse that he is very worried about his surgery. Which of the following responses by the nurse is a cliché?
A)
“Tell me what you are worried about.”
B)
“Have you spoken to your family about your concerns?”
C)
“Do you want to cancel your surgery?”
D)
“Don’t worry, everything will be fine.”

Answer 22

Ans:
D

Feedback:

A cliché is a stereotypical, trite, or pat answer. Most health care clichés suggest there is no cause for concern, or they often offer false assurance. Their use tends to be interpreted as a lack of real interest in what has been said.

Question 23

23.
A nurse tells a client, “Aren’t you going to get out of bed or are you just going to sleep all day and night?” This is an example of which of the following barriers to communication?
A)
Using comments that give advice
B)
Using judgmental or belittling language
C)
Using leading questions
D)
Using probing questions

Answer 23

Ans:
B

Feedback:

Using judgmental comments tends to impose the nurse’s standards on the client. In this case, the nurse judges the client as being lazy and the nurse’s apparent hostility could end effective communication.

Question 24

24.
A nurse is caring for a client who is visually impaired. Which of the following is a recommended guideline for communication with this client?
A)
Ease into the room without acknowledging presence until the client can be touched.
B)
Speak in a louder tone of voice to make up for lack of visual cues.
C)
Explain reason for touching client before doing so.
D)
Keep communication simple and concrete.

Answer 24

Ans:
C

Feedback:

For clients who are visually impaired, the nurse should acknowledge his or her presence in the client’s room, identify self by name, speak in a normal tone of voice, explain the reason for touching the client before doing so, and indicate to the client when the conversation has ended and when leaving the room.

Question 25

25. A client has been recently diagnosed with diabetes. He is seen in the emergency room every day with high blood sugar. The client apologizes to the nurse for bothering them every day, but he cannot give himself insulin injections. What should the nurse’s response be? A) “I myself cannot take insulin injections.” B) “Has someone taught you how to take them?” C) “You should learn to take injections yourself.” D) “Ask the doctor to change the medications.”

Answer 25

Ans: B Feedback: The nurse should assess whether the client has a knowledge deficit regarding self-injection. If there is a knowledge deficit, the nurse should educate the client in the correct method of taking insulin injections. Answer A is a negative reinforcement and is therefore inappropriate. Demanding that the client learn injection administration is also inappropriate. Answer D is inappropriate, because the nurse should not offer a change that cannot be carried out.

Question 26

26. A nurse pays a house visit to a client who is on total parenteral nutrition. The client expresses that he misses enjoying food with his family. What is the most appropriate response by the nurse? A) Tell me more about how it feels to eat with your family. B) You can sit with your family at meal times, even though you don’t eat. C) In a few weeks you may be allowed to eat a little; you may enjoy then. D) I know that you must be missing your favorite foods.

Answer 26

Ans: A Feedback: The nurse should help the client to verbalize his feelings and cope with aspects of illness and treatment. Asking open-ended questions is most appropriate as the nurse encourages the client to express his feelings. The other options block communication and are not appropriate. Telling the client that he can sit with his family but avoid eating does not consider the client’s feelings. Informing the client that he will be able to eat food in a few weeks changes the subject and stops communication. Stating that the client is missing his favorite dishes devalues the client’s feelings.

Question 27

27. A nurse is caring for a client with myasthenia gravis. The client is having difficulty forming words and his tone is nasal. Which of the following is an effective communication strategy for this client? A) Engage the client in a lengthy discussion to strengthen his voice. B) Encourage the client to speak quickly while talking. C) Repeat what the client has said to verify the meaning. D) Nod continuously when the client is talking.

Answer 27

Ans: C Feedback: The client is having a problem forming words and has a nasal tone due to a nerve involvement that controls speech. For effective communication, the nurse should repeat and verify whatever the client says. The nurse should ask those questions which can be answered in a yes or no form. Lengthy discussions may tire the client. Encouraging the client to speak quickly is inappropriate. Nodding continuously when the client is talking would not facilitate an effective communication strategy.

Question 28

``` 28. The nurse has engaged the services of an interpreter when interviewing a client who speaks a language that the nurse does not understand. The interpreter is functioning in which role during the communication process? A) Sender B) Encoder C) Receiver D) Communication channel ```

Answer 28

Ans: D Feedback: The interpreter’s role is that of a communication channel. A communication channel is the medium, the carrier of the message. The interpreter conveys the message sent by the client to the nurse. The client is the sender and the encoder of the message. The nurse is the receiver of the message.

Question 29

``` 29. A client comes to the clinic complaining of abdominal pain. Which first question would be most appropriate for the nurse to ask to facilitate the assessment? A) “Do you have sharp, stabbing pain?” B) “Is the pain associated with meals?” C) “What activities exaggerate the pain?” D) “Does the pain increase on palpation?” ```

Answer 29

Ans: C Feedback: “What activities exaggerate the pain?” is an open-ended question, because it gives the client an opportunity to express feelings and describe the pain. “Do you have sharp, stabbing pain?”; “Is the pain associated with meals?”; and “Does the pain increase on palpation?” are questions that can be answered with “Yes” or “No.” These questions would be helpful later in the assessment to help focus on the client’s statements.

Question 30

``` 30. When documenting client 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 client’s response to interventions ```

Answer 30

Ans: B Feedback: Documentation of care in the client’s record is most important for communicating with other health care team members that are involved in the care of the patient.

Question 31

``` 31. An older adult client 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 ```

Answer 31

Ans: A Feedback: The client’s two statements are incongruent with each other. This indicates the need for further education.

Question 32

32. Which of the following statements accurately describes the relationship between therapeutic communication and the nursing process? Select all that apply. A) Effective communication techniques, as well as observational skills, are used extensively during the assessment step. B) Only the written word in the form of a medical record is used during the diagnosing step of the nursing process. C) The implementing step requires communication among the client, nurse, and other team members to develop interventions and outcomes. D) Verbal and nonverbal communication are used to educate, counsel, and support clients and their families during the implementation phase. E) Nurses rely on the verbal and nonverbal cues they receive from their clients to evaluate whether client objectives have been achieved.

Answer 32

Ans: A, D, E Feedback: Effective communication techniques, as well as observational skills, are used extensively during the assessment phase, since the major focus of assessment is to gather information in both verbal and nonverbal communication forms. Following the formulation of the nursing diagnoses, the nurse communicates findings to other nursing professionals through the use of the written and spoken word. The planning step requires communication among the client, nurse, and other team members, as mutually agreed-upon outcomes are developed and interventions are determined. Verbal and nonverbal communication are employed to enhance basic caregiving measures and to educate, counsel, and support clients and their families during the implementation phase. Nurses often rely on the verbal and nonverbal cues they receive from their clients to verify whether client objectives have been achieved. Because one nurse cannot provide 24-hour coverage for clients, significant information must be passed on to others through nursing progress notes and care plans (documentation).

Question 33

33. A nurse who is discharging a client is terminating the helping relationship. Which of the following actions might the nurse perform in this phase? Select all that apply. A) Making formal introductions B) Making a contract regarding the relationship C) Providing assistance to achieve goals D) Helping client perform activities of daily living E) Examining goals of the relationship to determine their achievement

Answer 33

Ans: E Feedback: In the termination phase, the nurse examines with the client the goals of the helping relationship for indications of their attainment, or for evidence of progress toward them. If goals were not attained, the nurse should help the client establish a relationship with the new nurse. Answers A and B occur in the orientation phase, and answers C and D occur in the working phase.

Question 34

``` 34. A nurse tells a client that she will come back in 10 minutes to re-assess the client’s pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing? A) Empathy B) Sympathy C) Trust D) Closure ```

Answer 34

Ans: C Feedback: When a nurse repeatedly upholds commitments made to a client, it fosters foundational trust within the therapeutic relationship. The other options may be part of the therapeutic relationship, but in this case the nurse’s behavior will instill trust.

Question 35

``` 35. Which of the following should the nurse first consider when attempting to become culturally competent? A) Personal cultural beliefs and prejudices B) Understanding the client’s response C) Avoiding labeling clients D) Treating the client with dignity ```

Answer 35

Ans: A Feedback: The first step toward cultural competence requires becoming aware of your own personal cultural beliefs and prejudices.