Deck 14: Communicating With Patients and Co-Workers

Question 1

The RN has assigned the nursing assistant (NA) a task. The NA becomes angry and begins yelling at the RN. What is the best approach for the RN to take?

A) Tell the NA that you will let her leave early if she will do this for you.
B) Ignore her and reassign the task.
C) Meet with the NA to explore his or her feelings and the reason for resistance.
D) Call the nursing supervisor and report the NA for insubordination.

Answer 1

C
Meeting with the NA to explore the reason for resisting the request is the best approach in order to address the underlying issue. Telling the NA that you will let her leave early if she will do this for you and ignoring her and reassigning the task are negative reinforcements and will likely perpetuate the behavior. Calling the nursing supervisor and reporting the NA for insubordination should occur if the RN has been unsuccessful in resolving the problem.

Question 2

A patient has just been informed by the physician that he will not be discharged today. The nurse brings in the patient's lunch tray and puts it on the overbed tray. The patient pushes it off onto the floor and shouts, "Get out of my room and leave me alone." The nurse's most therapeutic response would be:

A) "Is there something wrong with your lunch tray?"
B) "You seem angry. Can you tell me about it?"
C) "Why are you angry? You seemed so much happier earlier today."
D) "I'll order you another lunch, and I'll be back when you're in a better mood."

Answer 2

B
"You seem angry. Can you tell me about it?" is the most therapeutic response. The nurse must project warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family. Additionally, empathy is the ability to perceive the patient's needs, feelings, and situation accurately. Additionally, asking open-ended questions allows the patient to express thoughts and feelings freely with no response limitations. The other answer items are not examples of a therapeutic response to the angry patient.

Question 3

The nurse and patient are discussing the patient's perceptions and feelings related to the patient's illness. The patient is emotional and tearful and expresses feelings of hopelessness. During which phase of the nurse-patient relationship does this typically occur?

A) Preorientation
B) Orientation
C) Working
D) Termination

Answer 3

C
Discussing perceptions and feelings typically occurs in the working phase, at which time intense emotions may arise. Preorientation is not a phase of the nurse-patient relationship. The orientation phase includes introductions and goal setting. The termination phase is the completion of the nurse-patient relationship as a result of discharge, transfer, or the nurse's time off.

Question 4

During the therapeutic relationship with a patient, which of the following is the primary focus of care?

A) Meeting the needs of the nurse
B) Medication administration
C) The patient's needs and problems
D) Self-care potential

Question 5

The nurse is caring for a patient following painful radiation treatment for newly diagnosed cancer. Which question, if asked by the nurse in the orientation phase of the nurse-patient relationship, is most likely to elicit a meaningful response?

A) "Don't you love this weather?"
B) "How have things been going for you?"
C) "Tell me why you didn't stop smoking."
D) "Are you having any pain?"

Question 6

The RN is documenting the patient's complaint of pain rated 6 on a scale of 0 to 10. Which chart entry would be the most appropriate, if made by the nurse?

A) Pt. complaining of pain. MD notified.
B) Pt complaining of pain rated at 6 on a scale of 0-10, states "My left leg is really hurting." Pt. grimacing, voice elevated. MD notified.
C) Pt. complaining of pain rated at 6 on a scale of 0-10. Appears to be in pain. MD notified.
D) Pt. complaining of pain rated 6. Wants more pain medication; appears to be drug-seeking. MD notified.

Question 7

The nurse is working in the outpatient clinic when a patient who has been waiting to be seen for an hour yells, "What are you people doing? I'm sick and tired of waiting!" Which response is the most therapeutic, if made by the nurse?

A) "The doctor can only do so much."
B) "Would you like a magazine?"
C) "I can see that you are frustrated."
D) "You need to be quiet!"

Question 8

Laura, a nurse manager, is meeting with the staff, which consists of nurses from the Veteran, Baby Boomer, Generation X, and Millennial generations. Which of the following is the best approach to encouraging collaboration and feedback from everyone?

A) Ask for volunteers to form a committee to explore the issue.
B) Form a committee made up of at least one representative from each generation.
C) Form a committee primarily composed of experienced, older nurses.
D) Meet with each nurse individually to solicit feedback.

Question 9

When preparing for patient teaching what should the nurse do first?

A) Assess the learner's needs.
B) List key points to be presented.
C) Collect the teaching materials.
D) Think about how the skill can be done at home.

Question 10

Which statement, if made by the nurse, is an example of a communication technique that can facilitate communication?

A) "Yes, I agree with you."
B) "You need to talk to your doctor."
C) "I know just how you feel."
D) "What are you thinking about?"

Question 11

A patient scheduled for surgery has a severe level of anxiety. Which action, if taken by the nurse, would be most appropriate at this time?

A) Providing teaching about the upcoming surgery and what to expect
B) Telling the patient that there is nothing to worry about
C) Calling the patient's family and demanding that they help out
D) Asking the patient about her concerns, feelings, and perceptions about the surgery

Question 12

When considering the creation of an environment for emotional support in a therapeutic relationship, the primary focus of the nurse should be:

A) removing stressors that cause anxiety and fear.
B) developing a trusting relationship.
C) encouraging the patient to become independent.
D) allowing the patient to be in control of medical decision-making.

Question 13

An example of a communication blocker is:

A) silence.
B) eye contact.
C) advising.
D) clarifying.

Question 14

The nurse is caring for a patient 2 hours after a left above-the-knee amputation. The patient states, "My left leg is really hurting, and that medicine you gave me earlier didn't help." Which response is the most therapeutic, if made by the nurse?

A) "That's impossible!"
B) "You'll have to talk to your doctor."
C) "Keep your chin up."
D) "I will call your physician."

Question 15

The nurse is caring for a 64-year-old woman 4 hours after knee replacement. Although she rates her pain at 6 out of 10, she refuses pain medication and tells the nurse, "I can deal with it." Which of the following is the nurse's best response?

A) "OK, that's your decision."
B) "You're just being stubborn."
C) "OK, I'll come back later."
D) "What is your concern?"

Question 16

The physician orders a dose of morphine that the nurse considers excessive. The nurse should:

A) administer the medication.
B) ask another nurse to administer the medication.
C) call the supervisor.
D) contact the physician.

Question 17

The instructor asks the nursing student to define therapeutic communication. The student's most appropriate response is that therapeutic communication refers to:

A) psychotherapy.
B) social communication.
C) developing a trusting relationship.
D) emotional commitment to another.

Question 18

Which of the following would be most appropriate to assess first for the newly admitted Chinese patient?

A) Pain
B) Language barrier
C) Family support
D) Religious preference

Question 19

A nurse has a plan for teaching the patient about a newly diagnosed disease. On entering the room the nurse realizes that the patient is blind. What considerations for communication should the nurse be aware of?

A) Tone, pitch, inflection, and intensity affect how messages are communicated.
B) Messages are clearer when verbal communication and nonverbal cues are opposite.
C) Verbal communication must be understood within the context of a patient's culture, gender, and age.
D) Facial expressions and eye contact are characteristics of verbal communication.

Question 20

The nursing student addresses an 86-year-old patient by his first name at their initial meeting. To the patient, this behavior:

A) is a sign of the nursing student's empathy for the patient.
B) could be interpreted as a lack of respect on the part of the student.
C) clearly indicates that the student feels comfortable working with the patient.
D) indicates that the student is establishing firm boundaries for the relationship.

Question 21

Before signing the verbal orders given earlier, the physician notifies the nurse of incorrectly wording the order. The physician requests the nurse to go back and insert the missing information. Which actions illustrate a lack of knowledge by the nurse? (Select all that apply.)

A) Use a black pen and insert the missing information.
B) Insist that the physician write a new order.
C) Write an addendum clarifying the order.
D) Toss the old order and write a new one.