Question 1

During an interview, a parent of a hospitalized child is sitting in a recliner with his legs extended and his arms at his sides. As the interviewer begins to discuss his son's treatment, however, he suddenly changes positions and crosses his arms against his chest and crosses his legs. What does this change in posture suggest?

Accepted Answer

The parent was in an open position, one in which there is extension of large muscle groups which shows relaxation, physical comfort, and a willingness to share information. However, he moved into a closed position, in which the arms and legs are crossed. This closed position tends to look defensive and anxious. If a person in a relaxed position suddenly tenses, then this change in posture suggests possible discomfort with the new topic. The parent's position should be noted. If a person in an opened, relaxed position (legs and arms extended) suddenly tenses and moves to a closed position (arms and legs crossed)then this change in posture suggests possible discomfort with the new topic and is more than just changing positions to get comfortable or needing a break.

Question 2

In using verbal responses to assist the patient's narrative, some responses focus on the patient's frame of reference and some focus on the health care provider's perspective. Which is an example of a verbal response that focuses on the health care provider's perspective?

Accepted Answer

When the health care provider uses the response of confrontation, the frame of reference shifts from the patient's perspective to the perspective of the health care provider, and the health care provider starts to express his or her own thoughts and feelings. Empathy, reflection, and facilitation responses focus on the patient's frame of reference. Empathy, reflection, and facilitation responses focus on the patient's frame of reference. Confrontation focuses on the health care provider's frame of reference and involves the health care provider expressing his or her own thoughts and feelings.

Question 3

The nurse is conducting an interview with a woman who has recently learned that she is pregnant and who has come to the clinic today to begin prenatal care. The woman states that she and her husband are excited about the pregnancy but have a few questions. She looks nervously at her hands during the interview and sighs loudly. Considering the concept of communication, which statement does the nurse know to be most accurate when describing this woman?

Accepted Answer

Communication is all behaviors, conscious and unconscious, verbal and nonverbal. All behaviors have meaning. Her behavior does not imply that she is nervous about labor, upset by her husband, or worried about the nurse's response.

Question 4

During an interview, a woman says, "I have decided that I can no longer allow my children to live with their father's violence, but I just can't seem to leave him." Using interpretation, which would be the best response by the nurse?

Accepted Answer

The statement "It sounds as if you might be afraid of how your husband will respond" is linking events, making associations, and implying cause, which are what occur in interpretation. Interpretation also recognizes feelings and helps the person understand his or her own feelings in relation to the verbal message. The other statements do not reflect interpretation. The statement "You are going to leave him?" is a direct question, not an interpretation. The statements "If you are afraid for your children, then why can't you leave?" and "It sounds as though you have made your decision. I think it is a good one" do not recognize the person's feelings or link events, make associations, or imply cause. In addition, in the latter statement the nurse is providing his or her opinion which is inappropriate.

Question 5

A nurse is taking complete health histories on all of the patients attending a wellness workshop. On the history form, one of the written questions asks, "You don't smoke, drink, or take drugs, do you?" This is an example of what type of question?

Accepted Answer

This question is an example of using leading or biased questions. Asking, "You don't smoke, do you?" implies that one answer is better than another. If the person wants to please someone, then he or she is either forced to answer in a way that corresponds to his or her implied values or is made to feel guilty when admitting the other answer. Talking too much, using confrontation, or using blunt language to deal with distasteful topics are not types of questions. Asking, "You don't smoke, do you?" is a biased or leading question because it implies that one answer is better than another. If the person wants to please someone, then he or she is either forced to answer in a way that corresponds to his or her implied values or is made to feel guilty when admitting the other answer.

Question 6

The nurse has used interpretation regarding a patient's statement or actions. What should the nurse do after using this technique?

Accepted Answer

The nurse's, or interviewer's, interpretation of a patient's statement is based on their inference or conclusion. The nurse risks making the wrong inference. Pausing after an interpretation allows time for the patient to correct it if it is wrong. Even if the inference is correct, interpretation helps prompt further discussion of the topic. Apologizing after interpreting a patient's statement should not be necessary as the nurse should have stated that the interpretation is just his or her own inference from what the patient said and not a conclusion and is open for clarification. Continuing the interview as if nothing has happened or immediately restating the nurse's conclusion based on the patient's nonverbal response does not allow time for the patient to confirm or correct the inference.

Question 7

During a visit to the clinic, a patient states, "The doctor just told me he thought I ought to stop smoking. He doesn't understand how hard I've tried. I just don't know the best way to do it. What should I do?" What is the most appropriate response by the nurse?

Accepted Answer

Clarification should be used when the person's word choice is ambiguous or confusing. Clarification is also used to summarize the person's words or to simplify the words to make them clearer; the nurse should then ask if he or she is on the right track. The other responses give unwanted advice or do not offer a helpful response. Saying "I'd quit if I were you. The doctor really knows what he is talking about", "Stopping your dependence on cigarettes can be very difficult. I understand how you feel", or "Why are you confused? Didn't the doctor give you the information about the smoking cessation program we offer?" either provide unwanted advice or do not offer a helpful response.

Question 8

The nurse asks, "I would like to ask you some questions about your health and your usual daily activities so that we can better plan your stay here." Based on this question, the nurse is at which phase of the interview process?

Accepted Answer

When gathering a complete history, the nurse should give the reason for the interview during the opening or introduction phase of the interview, not during or at the end of the interview.

Question 9

In an interview, the nurse may find it necessary to take notes to aid his or her memory later. Which statement is true regarding note-taking?

Accepted Answer

The use of history forms and note-taking may be unavoidable. However, the nurse must be aware that note-taking during the interview has disadvantages, one of which is impeding the nurse's observations of the patient's nonverbal behavior. Note-taking often interrupts the patient's narrative flow, rather than allowing them to keep their own pace. Note-taking can break eye contact and also shift the nurse's attention away from the patient which can diminish the patient's sense of importance.

Question 10

A woman has just entered the emergency department after being battered by her husband. The nurse needs to get some information from her to begin treatment. What is the best choice for an opening phase of the interview with this patient?

Accepted Answer

The nurse should address the person by using his or her surname as automatic use of the first name is too familiar for most adults and lessens dignity. The nurse should introduce him or herself and give the reason for the interview. Friendly small talk is not needed to build rapport. The nurse should not initially address a patient by their first name as automatic use of the first name is too familiar for most adults and lessens dignity. Statements such as "How are you today" and "It sure is cold out today" are small talk and are not necessary to build rapport.

Question 11

During an interview, the nurse states, "You mentioned having shortness of breath. Tell me more about that." Which verbal skill is used with this statement?

Accepted Answer

Open-ended questions ask for narrative information and give the patient free rein. They state the topic to be discussed but only in general terms, which is what the statement in this question does. The nurse should use open-ended questions to begin the interview, to introduce a new section of questions, and whenever the person introduces a new topic. Reflection and facilitation refer to the nurse's (interviewer's) verbal response of their reactions to the facts or feeling the patient has communicated. Direct questions elicit a one or two word answer such as yes or no. The statement in this question is eliciting more than a yes or no response, so it is not a direct question. Instead the statement in the question is an open-end question allowing the patient free rein on what to say.

Question 12

A pregnant woman states, "I just know labor will be so painful that I won't be able to stand it. I know it sounds awful, but I really dread going into labor." The nurse responds by stating, "Oh, don't worry about labor so much. I have been through it, and although it is painful, many good medications are available to decrease the pain." Which statement is true regarding the nurse's response?

Accepted Answer

By saying "Oh, don't worry about labor so much. I have been through it, and although it is painful, many good medications are available to decrease the pain" the nurse is providing false assurance or reassurance. This may give the nurse a false sense of having provided comfort. However, for the woman, providing false assurance or reassurance actually trivializes her anxiety, and effectively denies any further talk of it, thus, closing off communication. The nurse's statement, "Oh, don't worry about labor so much. I have been through it, and although it is painful, many good medications are available to decrease the pain" is not therapeutic because it trivializes the patient's anxiety about pain, and effectively denies any further talk of it, thus, closing off communication.

Question 13

As the nurse enters a patient's room, the nurse finds the patient crying. The patient states that she has just found out that the lump in her breast is cancer and says, "I'm so afraid of, um, you know." Which would be the most therapeutic response by the nurse when said in a gentle manner?

Accepted Answer

This statement demonstrates reflection. Reflection echoes the patient's words, repeating part of what the person has just said, and it also can help express the feelings behind a person's words. Stating "No, I'm not sure what you are talking about" is not the most therapeutic response as it does not acknowledge the patient's feelings. Stating "I'll wait here until you get yourself under control, and then we can talk" or "I can see that you are very upset. Perhaps we should discuss this later" are not therapeutic as they are not addressing the patient's feelings and concerns at the time.

Question 14

When taking a history from a newly admitted patient, the nurse notices that he often pauses and expectantly looks at the nurse. What would be the nurse's best response to this behavior?

Accepted Answer

Typically patients will answer questions with short answers and then pause and look to the health care provider for direction on whether to continue. In this case, the health care provider should lean forward slightly, make eye contact, and look interested and if the patient does not continue, then ask them to tell you more or ask if there anything else. The other responses are not conducive to ideal communication. Leaning back in the chair or standing up indicates disinterest or closure and making statements such as "Don't worry about all of this. I'm sure we can get to the bottom of your symptoms;" "You are looking at me kind of funny; there isn't anything wrong, is there?"; or "I can see that this interview is uncomfortable for you. We can continue it another time" dismiss the patient's feelings or are confrontational and are not conducive to ideal communication.

Question 15

When observing a patient's verbal and nonverbal communication, the nurse notices a discrepancy. What action should the nurse take in this situation?

Accepted Answer

When nonverbal and verbal messages are congruent, the verbal message is reinforced. When they are incongruent, as in this case, the nonverbal message tends to be the true one because it is under less conscious control. The other statements are not true. When nonverbal and verbal messages are incongruent, as in this case, the nonverbal message tends to be the true one because it is under less conscious control. Thus, asking someone who knows the patient well to help interpret this discrepancy; focusing on the patient's verbal message, and trying to ignore the nonverbal behaviors; and trying to integrate the verbal and nonverbal messages and then interpret them as an average are inappropriate.

Question 16

A woman is discussing the problems she is having with her 2-year-old son. She says, "He won't go to sleep at night, and during the day he has several fits. I get so upset when that happens." Which is the best response by the nurse to gain a better understanding of the problem?

Accepted Answer

The nurse should use clarification when the person's word choice is ambiguous or confusing (e.g., "Tell me what you mean by fits."). Clarification is also used to summarize the person's words or to simplify the words to make them clearer; the nurse should then ask if he or she is on the right track. Telling the woman "Go on, I'm listening"; "Yes, it can be upsetting when a child has a fit"; or "Don't be upset when he has a fit; every 2 year old has fits" does not allow the nurse to clarify what the woman means by the term "fits" which is necessary to gain a better understanding of the problem. The nurse should use clarification when the person's word choice is ambiguous or confusing (e.g., "Tell me what you mean by fits."). Clarification is also used to summarize the person's words or to simplify the words to make them clearer; the nurse should then ask if he or she is on the right track.

Question 17

A patient has finished giving the nurse information about the reason he is seeking care. When reviewing the data, the nurse finds that some information about past hospitalizations is missing. At this point, which statement by the nurse would be most appropriate to gather these data?

Accepted Answer

The nurse should use direct questions after the person's opening narrative to fill in any details he or she left out. The nurse also should use direct questions when specific facts are needed, such as when asking about past health problems or during the review of systems. The nurse should not assume that a patient has been hospitalized based on their age and stating such is inappropriate. Getting the patient's medical records from another facility is not necessary during the interview process. Asking the patient to tell you more about hospitalization in order to complete missing interview data is not necessary; instead, direct questions should be asked when specific facts are needed.

Question 18

Which adjustment in the physical environment should the nurse make to promote the success of an interview?

Accepted Answer

The nurse should secure a quiet environment, thus, should reduce noise by turning off the television, radio, and other unnecessary equipment, because multiple stimuli are confusing. The interviewer and patient should be approximately 4 to 5 feet apart; the room should be well-lit, enabling the interviewer and patient to see each other clearly. Having a table or desk in between the two people creates the idea of a barrier; equal-status seating, at eye level, is better. Having a table or desk in between the two people creates the idea of a barrier; equal-status seating, at eye level, is better. The interviewer and patient should be approximately 4 to 5 feet apart. Sitting closer than that to a patient, or encroaching on them, can cause anxiety. The room should be well-lit, enabling the interviewer and patient to see each other clearly.

Question 19

A 17-year-old single mother is describing how difficult it is to raise a 3-year-old child by herself. During the course of the interview she states, "I can't believe my boyfriend left me to do this by myself! What a terrible thing to do to me!" Which of these responses by the nurse uses empathy?

Accepted Answer

An empathetic response recognizes the feeling and puts it into words. It names the feeling, allows its expression, and strengthens rapport. Some empathetic responses are, "This must be very hard for you," "I understand," or simply placing your hand on the person's arm. Simply reflecting the person's words or agreeing with the person is not an empathetic response. Simply reflecting the person's words by saying "You feel alone" or "You can't believe he left you alone", or agreeing with the person by saying "I would be angry, too; raising a child alone is no picnic" are not empathetic responses. They do not name the feeling, allow its expression or strengthen rapport.

Question 20

Receiving is a part of the communication process. Which receiver is most likely to misinterpret a message sent by a health care professional?

Accepted Answer

In addition to a receiver interpreting a sender's message based on their past experiences, culture, and self-concept, physical and emotional states also play a role in interpretation. The man whose wife has just been diagnosed with lung cancer may be experiencing emotions that affect his receiving. The receiver attaches meaning determined by his or her experiences, culture, self-concept, and current physical and emotional states. The man whose wife has just been diagnosed with lung cancer may be experiencing emotions that affect his receiving.

Quiz 3: The Interview