Question 1

A patient yells at the nurse frequently and uses profane language. Which of the following is the most appropriate response by the nurse?

Accepted Answer

Assertive responses contain "I" statements that take responsibility. This behavior is in contrast to aggressive behavior, which has a goal of dominating while suppressing the other person's rights. The goal of assertiveness is to communicate directly, standing up for one's personal rights while respecting the rights of others. Conflict creates anxiety, which may prevent one from behaving assertively. Aggressive behavior has a goal of dominating while suppressing the other person's rights. Aggressive responses often consist of "you" statements that fix blame on the other person. Assertive behaviors range from making a direct, honest statement about one's beliefs to taking a very strong, confrontational stand about what will and will not be tolerated in the relationship.

Question 2

The initial interpersonal strategy to help the patient reduce strong emotion to a workable level involves

Accepted Answer

The initial interpersonal strategy used to help patients reduce strong emotion to a workable level is to provide a neutral, accepting, interpersonal environment. The second step in defusing the strength of an emotion is to talk the emotion through with someone. The third phase is to take action. The specific needs expressed by the emotion suggest actions that might help the patient come to terms with the consequences of the emotion. This responsibility might take the form of obtaining more information or of taking some concrete risks to change behaviors that sabotage the goals of the relationship.

Question 3

Which of the following are strategies the nurse should use when dealing with an angry patient?

Accepted Answer

The nurse should defuse hostility by avoiding responding to a patient's anger by becoming angry also. The nurse should use empathy in his or her communication. An angry patient needs to have the nurse acknowledge both the issue and his or her feelings about that issue. Only then can the patient begin to interact in a meaningful way. Empathy by the nurse may help defuse the situation. The nurse should deliberately begin to lower his or her voice and speak more slowly. When we get upset, we tend to speak quickly and use a higher tone of voice. If the nurse does the opposite, the patient may begin to mimic him or her and thus calm down. The goal is to maintain safety while helping the patient. Therefore, it may not always be appropriate to remain with the patient because this may place the nurse in danger of physical harm. If the nurse feels in danger of physical harm, he or she should always maintain a space for safety and plan an exit.

Question 4

A nurse manager is educating nurses about the risk of violence experienced by nurses and social workers in their workplace when compared to other professionals. The nurse manager states that nurses and social workers are at

Accepted Answer

Violence against health care workers is increasing. Nurses are at greater risk because of their close contact with patients. In fact, nurses and social workers are at three times greater risk to experience violence in their workplace than are other professionals.

Question 5

Which of the following best describes the goal of assertiveness?

Accepted Answer

Assertive behavior is defined as setting goals; acting on those goals in a clear, consistent manner; and taking responsibility for the consequences of those actions. Assertive communication is conveying this objective in a direct manner, without anger or frustration. The assertive nurse is able to stand up for personal rights and the rights of others.

Question 6

When a physician writes an order for the nurse to withhold life-saving treatment from a terminally ill patient, the nurse is faced with two different choices, each supported by a different ethical principle. This type of conflict is known as

Accepted Answer

A conflict can be internal (intrapersonal); that is, it can represent opposing feelings within an individual. Intrapersonal conflict arises when nurses are faced with two different choices, each supported by a different ethical principle. More often, conflict is covert and not so clear-cut. The conflict issues are hidden. The patient talks about one issue, but talking does not seem to help and the issue does not get resolved. Overt conflict refers to conflict that is observable in the patient's behavior and expressed verbally. Interpersonal conflict occurs between two or more people.

Question 7

A patient states to the nurse in a hostile voice, "I am sick of being poked at and stuck with needles. Go away and leave me alone." Which of the following is the best statement by the nurse?

Accepted Answer

Validating the anger and reframing are useful. Comments such as, "I'm sorry you are feeling so upset," recognize the significance of the emotion being expressed without getting into the cause. "I am not surprised that you wish to be left alone" validates the patient's anger, but does not reframe the situation. The nurse should not make inferences about what the patient is feeling without first validating. "Okay, I will go away" is avoidant behavior by the nurse.

Question 8

A patient yells, "Take this mess away from here. How could anyone eat this food? What kind of place are you running here?" The nurse uses skills of assertiveness to promote change that is focused on

Accepted Answer

Undesired behaviors, not feelings, attitudes, and motivations, are the focus for change. Feelings, attitudes, and motivations are not the focus for change.

Question 9

The nurse's first response in dealing with a conflict situation that involves a patient is to

Accepted Answer

Conflicts between nurse and patient are not uncommon. The first step for the nurse is to gain a clear understanding of one's own personal response. No one is equally effective in all situations. The second step is to understand the context of the situation. Most interpersonal conflicts involve some threat to one's sense of control or self-esteem. Nurses have been shown to respond to the stress of not having enough time to complete their work by imposing more controls on the patient, who then often reacts by becoming more difficult. Other situations, which may lead to conflict between the nurse and the patient, include having statements discounted.

Question 10

When working in situations that involve conflict, the nurse recognizes that which of the following is true in relation to conflict?

Accepted Answer

Conflict has been defined as tension arising from incompatible goals or needs, in which the actions of one frustrate the ability of the other to achieve a goal, resulting in stress or tension. Conflicts in any relationship are inevitable: they serve as warning that something in the relationship needs closer attention. Conflict can lead to improved relationships. Most people experience conflict as discomfort.

Question 11

The most effective problem-solving style for genuine resolution that creates a win-win situation is

Accepted Answer

Collaboration is a solution-oriented response in which individuals work together cooperatively to problem solve. To manage a conflict, those involved commit to finding a mutually satisfying solution. This involves directly confronting the issue, acknowledging feelings, and using open communication to solve the problem. Steps for productive confrontation include: identifying concerns of each party; clarifying assumptions; communicating honestly to identify the real issue; and working collaboratively to find a solution that satisfies everyone. This is considered to be the most effective style for genuine resolution. This is a win-win situation. Accommodation is a lose-win situation. Avoidance can turn into a lose-lose situation. Competition can lead to a lose-lose situation.

Question 12

The nurse is caring for an intoxicated patient who has been admitted to the emergency department. The patient appears very angry and frequently shouts at the nurse and demands to see the physician. The best response by the nurse is to use

Accepted Answer

Effective nurse-patient communication is critical to efficient care provision and to providing quality care. Knowing how to respond in emotional situations allows the nurse to use feelings as a positive force. Nurses often find themselves in dramatic situations in which a calm response is required. Some patients approach their initial encounter with a nurse with hostility or embarrassment, such as the intoxicated patient admitted to an emergency department. To listen and to respond creatively to intense emotion when the nurse's first impulse is to withdraw or to retaliate demands a high level of skill. It requires self-control and empathy for what the patient may be experiencing. The nurse should avoid blaming, which will only make the patient feel defensive or angry. Competition is a response style characterized by domination. In this contradictory style, one party exercises power to gain his own goals at the expense of the other person. It is characterized by aggression and lack of compromise. Authority may be used to suppress the conflict in a dictatorial manner. This leads to increased stress. It is an effective style when there is a need for a quick decision, but it leads to problems in the long term, making it a lose-lose situation. Timing is also important if an individual is very angry. The key to assertive behavior is choice. Sometimes it is better to allow the patient to let off some "emotional steam" before engaging in conversation.

Question 13

When providing home health care to a patient suffering from Alzheimer's disease who fell and broke his hip 3 weeks ago, the nurse teaches the patient's family correct use of the walker. This represents which stage of the nurse-caregiver relationship?

Accepted Answer

A Canadian study of home health nurses and family caregivers of elderly relatives identified four evolving stages in the nurse-caregiver relationship. The initial stage is "worker-helper," with the nurse providing care to the ill patient with the family helping. Next comes "worker-worker," when the nurse begins teaching the needed care skills to family members. Third is "nurse as manager; family as worker," as the family members learn needed care skills. The final stage, "nurse as nurse for family caregiver," occurs as the family member becomes exhausted. In the worker-helper stage, the nurse provides care to the ill patient with the family helping. In the nurse as manager; family as worker stage, the nurse acts as manager with the family learning care skills. In the nurses as nurse for family caregiver stage, the family member is exhausted and the nurse cares for him or her as well as the patient.

Question 14

A patient on a psychiatric unit is found pacing the halls and angrily punching at the wall. The nurse's primary goal should be to

Accepted Answer

The nurse should help the patient own the angry feelings by getting the patient to verbalize things that make him or her angry. Acknowledging a patient's anger may prevent an expression of abusive ranting. It is essential that the nurse use empathetic statements or active listening to acknowledge the patient's anger and maintain a nonthreatening demeanor before moving on to try to discuss the issue. The goal is to maintain safety while helping the patient. Psychiatric patients can be unpredictable and at this point would not be likely to respond positively to a suggestion such as writing in a journal. Speaking assertively or in a loud voice may escalate the situation, and the patient is already out of control.

Question 15

Which of the following is true about assertion communication?

Accepted Answer

Components of assertion communication include the following four abilities to: (1) say no, (2) ask for what you want, (3) appropriately express both positive and negative thoughts and feelings, and (4) initiate, continue, and terminate the interaction.

Question 16

The nurse is teaching an unlicensed assistive personnel (UAP) on potential approaches for dealing with difficult patients. The nurse recognizes that additional teaching is required when the UAP states

Accepted Answer

Potential approaches for dealing with difficult patients include using a calm tone and avoiding conveying irritation. Potential approaches for dealing with difficult patients also include: working with staff so all use the same uniform approach to the patient's demands; promoting trust by providing immediate feedback; and explaining the limits of one's role.

Question 17

After fasting from 10 p.m. the previous evening, a patient learns that the procedure has been cancelled. The patient curses at the nurse and accuses the nurse of being incompetent. The nurse's best response would be

Accepted Answer

Assertive behaviors range from making a direct, honest statement about one's beliefs to taking a very strong, confrontational stand about what will and will not be tolerated in the relationship. Assertive responses contain "I" statements that take responsibility. This behavior is in contrast to aggressive behavior, which has a goal of dominating while suppressing the other person's rights. Aggressive responses often consist of "you" statements that fix blame on the other person. "We" statements should be used only when the nurse actually means to look at an issue collaboratively. Thus, the statement, "Perhaps we both need to look at this issue a little closer." may be appropriate in certain situations. However, the statement, "Perhaps we shouldn't get so angry when things don't work out the way we think they should." is a condescending statement thinly disguised as a collaborative statement. What is actually being expressed is the expectation that both parties should handle the conflict in one way-the nurse's way. Some nurses were socialized to act passively. Passive behavior is defined as a response that denies our own rights in order to avoid conflict.

Question 18

When interacting with the nurse, a patient makes several condescending remarks directed toward the nurse. The nurse recognizes this behavior as an example of

Accepted Answer

Nonverbal clues to anger include grimacing, clenching jaws or fists, turning away, and refusing to maintain eye contact. Verbal clues by a patient may, of course, include use of an angry tone of voice, but they may also be disguised as witty sarcasm or as condescending or insulting remarks. The patient's remarks are condescending, not humorous. The patient's remarks are verbal, not nonverbal. Use of condescending remarks is an example of passive-aggressive communication.

Quiz 13: Resolving Conflicts Between Nurse and Patient