Question 1

The nurse is interviewing a patient about his health history.Which statement by the nurse is most likely to result in effective patient communication?

Accepted Answer

The nurse communicates effectively by using focused questions.This encourages the patient to give more information about the specific topic of concern.The remaining options are ineffective communication techniques because each impairs the exchange of information between the nurse and the patient.The patient may be unwilling to express concerns openly after the nurse expresses lack of understanding and empathy.The patient will also likely lose confidence in the nurse if the nurse expresses confusion about suitability of the patient's presence.By asking what is important to the patient,the nurse loses focus of the objective of the communication and is likely to confuse the patient.

Question 2

The patient tells the nurse,"I want to die." Which is the best response by the nurse to facilitate therapeutic communication?

Accepted Answer

The patient's statement warrants further investigation to determine how serious the patient is about dying and whether he or she has a plan.Research on suicide supports the claim that patients with well-established suicide plans are more likely to carry out the plan; thus details about the patient's feelings on dying and suicide plans are important for preventing self-injury and planning medical therapy,nursing care,and patient safety.To elicit more information from the patient,the nurse allows the patient to expand on the statement,"I want to die" by stating,"Tell me more." The statement displays concern for and value of the patient by acknowledging the patient's message and encouraging him or her to continue.Safety is a major concern when a patient wants to die,and the remaining options are unlikely to further the discussion,keep the patient safe,or facilitate therapeutic communication.

Question 3

A female patient sobs uncontrollably when talking about the recent death of a pet.Which response should the nurse implement to best provide for her immediate needs?

Accepted Answer

Sitting with the patient demonstrates acceptance,caring,and value for the patient's experience as she expresses her grief.This is more likely to promote effective communication later because the nurse establishes a foundation of trust by respecting,caring,and staying with her.Providing tissues is indicated; however,leaving the room indicates that the nurse does not value what the patient is experiencing,the nurse does not care,or the nurse is uncomfortable with crying.Questions beginning with "why" ask the patient to justify feelings or actions and thereby can inhibit effective communication as she assumes a defensive position.The patient needs to be able to experience the grief.She will talk when she is ready.

Question 4

The nurse is teaching the patient about weight management,and the patient wants to know how the nurse manages to stay "so thin." Which response should the nurse use to maintain therapeutic communication?

Accepted Answer

After acknowledging the patient's question,the nurse redirects the conversation to weight management because therapeutic communication is patient centered and goal oriented; however,the communication and the goal do not involve personal details about the nurse because therapeutic communication is not social conversation.Describing a daily routine reveals personal information that belies the nurse-patient relationship.Telling the patient that a healthcare background is needed to implement the nurse's plan is condescending and conveys a lack of respect.

Question 5

The nursing staff is using the SBAR communication technique during patient hand-off communication.The circumstances leading up to the current status would be explained by the nurses during which step of the technique?

Accepted Answer

The background explains circumstances leading up to the situation.The situation explains what is happening at the present time.The assessment phase identifies what the problem is thought to be.The recommendations explain how to correct the problem.

Question 6

The patient shouts at the nurse,"No one answered my call bell all night!" Which response should the nurse use with this patient to restore therapeutic communication?

Accepted Answer

Regardless of whether the nurses answered the patient's call bell during the night,the patient felt ignored.By empathizing with the patient's distress and reflecting feelings,the nurse displays respect and understanding of his or her experience.Reprimanding the patient is humiliating and conveys the nurse's lack of regard for the patient's feelings.Quieting the patient is achievable by displaying empathy,caring,respect,and willingness to hear his or her complaints.Questioning the patient's perception is demeaning and forces the patient to justify feelings,similar to asking a "why" question.Stating that the unit has very sick patients implies that the patient is not as important as the others are,potentially leads to patient feelings of guilt and shame,and is likely to impair therapeutic communication for making an issue of a lack of attention.

Question 7

The nurse is preparing to begin the patient hand-off procedure for five patients.Who should the nurse include in this process?

Accepted Answer

All the healthcare personnel on the unit who will be interacting with this group of patients should actively participate in the patient hand-off.This would include nursing assistive personnel (NAP)and the nurses.An interdisciplinary team usually meets when there is a problem with a patient and all the team members need to discuss approaches and plans with and for a patient.The healthcare provider does not participate in the patient hand-off procedure.The provider makes rounds on a specific group of patients.

Question 8

The nurse is caring for a patient who refuses to participate in physical therapy (PT)and states,"I really don't like to exercise." Which response by the nurse is most likely to help engage the patient in PT?

Accepted Answer

The nurse asks an open-ended question using the patient's words to uncover information about the patient's refusal to participate in PT by asking what the patient dislikes about exercise.Using the patient's words conveys acceptance and value because the nurse listened closely enough to repeat what the patient said; in addition,the nurse is asking the patient to continue describing his or her pain to uncover factors that can be resolved or other issues requiring follow-up care and ultimately result in patient participation.Asking the patient a yes-or-no question such as,"It makes the pain worse,doesn't it?" is unlikely to promote further discussion.Telling the patient to do the exercises is giving advice; rather the nurse can tell the patient the reason for the therapy and the benefits of doing it or the risks of not doing it.Asking about other activities moves the focus away from the patient's need for physical therapy.

Question 9

The patient tells the nurse,"I must be very sick because so many tests are being performed." Which statement does the nurse use to reflect the patient's message?

Accepted Answer

The nurse reflects the patient's message by focusing on the feelings the patient identifies,including nonverbal cues,and then clarifying the nurse's perception with the patient.The nurse follows this statement by encouraging the patient to confirm the perception.Pointing out that the patient has stated this before can be misinterpreted to mean that the patient is forgetful or annoying.Stating that the nurse feels that the patient is worried is a suitable response but does not reflect what the patient actually said.Exploring the topic with the patient is a suitable response but does not reflect the patient's actual statement.

Question 10

You are working with a patient who is cognitively impaired and you need to provide some information to them.Which should the nurse implement in response to the patient's condition?

Accepted Answer

Use clear and concise verbal techniques to respond to the patient.Use simple language and speak slowly; use short,simple sentences.Ask yes or no questions,ask one question at a time,and repeat the information.The patient is unable to clearly communicate needs or concerns in the present state because he or she needs comfort and support in a threatening situation.Having another person complete the interview may convey a lack of respect and lead to patient confusion if the other person does not make sure that the patient understands all the information.

Question 11

A patient's mother died several days ago.The patient begins to cry and states,"The pain of her death is impossible to bear." Which statement by the nurse is the most effective response?

Accepted Answer

The nurse conveys empathy and respect by acknowledging the patient's grief.This is an effective response and is likely to enhance the nurse-patient relationship because it is patient centered,displays caring and respect,and helps to make the patient feel accepted.Relating personal details about the nurse's life redirects the focus of the communication to the nurse and fails to support the objectives of the nurse-patient relationship.Responding with a comment about the patient's progress and asking about the cardiologist's appointment ignores the patient's grief and conveys a lack of respect and consideration.

Question 12

The nurse is explaining a procedure to a 3-year-old female patient.Which strategy should the nurse use for patient teaching?

Accepted Answer

Using dolls,stuffed animals,or puppets with stories is a suitable way to explain surgery to the 3-year-old patient because storytelling is a familiar communication method for the toddler's developmental stage.A 3-year-old child is unlikely to understand an explanation about the surgery suited for an adult,and the discussion can frighten the child and upset the family or guardian.A 3-year-old child lacks the fine motor and cognitive skills to draw an abstract concept.Needles,syringes,and bandages usually are not shown to patients of any developmental level because many people at various ages are fearful of needles and pain.A toddler is unlikely to understand and probably would be frightened by a discussion about postoperative pain.

Question 13

After a male patient receives a diagnosis of a fatal disease,he expresses sadness and states that he does not know what to do next.Which is the most effective response by the nurse to facilitate communication?

Accepted Answer

Because of the grim diagnosis,the patient expresses confusion and lacks a clear direction.To reduce anxiety,enhance coping skills,and facilitate communication,the nurse provides a calm atmosphere by redirecting and focusing the patient to identify comforting things.The nurse should use comfort measures,hoping that they will reduce tension so the patient can process information and make decisions.Discussing hospice is premature until end-stage disease and because the patient is not thinking clearly.The patient can benefit from a calming atmosphere and time to process the new information.Besides,informing the patient about hospice implies that end of life is imminent.Assuring the patient of family involvement requires consultation with the family first.Spiritual counseling may not be indicated for this patient if the patient does not wish to participate.

Question 14

The nurse brings the patient's medications into the room,and the patient shouts,"You don't care if I take these,so get out of my room!" Which response by the nurse is most likely to diminish the patient's anger?

Accepted Answer

To neutralize the situation,the nurse seeks to confirm an impression by sharing an observation about the patient's actions and encourages the patient to communicate about the anger to help keep him or her in control and elicit more discussion about his or her emotional state.The nurse's statement also expresses caring and respect for the patient.Questions beginning with "why" are confrontational and not likely to diminish anger.Confronting the patient with questions is more likely to escalate anger and force the patient to justify statements.When the nurse attempts to control the patient by stating that the medications must be administered before the nurse can leave the room,the nurse may succeed in administering the medications; however,controlling behavior is confrontational because the nurse engages the patient in a power struggle and misses an opportunity to explore the patient's anger.Forcing the patient in this manner is unlikely to elicit patient cooperation in the future because the nurse has displayed a lack of caring and respect.

Question 15

The nurse is assessing a patient for pain.Which question is best for the nurse to ask when determining aggravating factors for a patient's pain?

Accepted Answer

Aggravating factors make the pain worse or increase its severity,so the nurse asks about what increases the intensity of the pain to determine aggravating factors.The nurse asks the patient about the duration of the pain when asking how long the patient has had it.This is important to know but doesn't explain any of the factors that either trigger the pain or make it worse.Asking the patient to identify a specific spot for the pain determines its location but does not identify aggregating factors.Rating the pain on a scale transforms the patient complaint into objective data that are helpful in establishing trends and response to therapy.

Question 16

The nurse interviews a female patient during admission.Which observation by the nurse identifies congruency in the patient's communication?

Accepted Answer

The patient demonstrates congruency,or consistency,between her verbal statement asking for an explanation and her nonverbal cue of listening intently.The verbal and nonverbal messages match; each indicates that the nurse's response is important to her.If she is eager to answer questions,the patient should focus on the nurse's questions or note taking; reading a magazine is a distraction and indicates a lack of interest.Changing the subject may indicate discomfort or reluctance to address the issue.Continually shifting position may be an indication of anxiety.

Question 17

The nurse is caring for a patient who states,"I don't feel well today." Which is the best follow-up action to the patient's statement for the nurse to implement?

Accepted Answer

Because the patient's statement is too vague,the nurse asks him or her to continue describing,"I don't feel well today," because many disorders begin with nonspecific complaints.Depending on the details the patient shares,the nurse plans and implements nursing care individualized to his or her description.This is a better choice than taking vital signs or checking test results because principles of diagnostics mandate completing the patient history before objective data; a good diagnostician should be able to formulate a reasonable prognostication about the patient's actual health alteration with the history alone.

Question 18

A male patient who says that his parents died of heart disease early in life is waiting for diagnostic testing results.He is biting his nails and pacing around the room.Which statement should the nurse use to clarify patient information?

Accepted Answer

Asking for more information about the family's history directs the patient to expand on a specific,pertinent topic and relate key details before moving to another topic."Early in life" and "heart disease" need to be defined by the patient; "early in life" can indicate a wide range of ages,depending on the definition of "early," and "heart disease" can mean conditions such as heart failure,coronary artery disease,valve disease,and arrhythmias.Until the patient discusses his particular concerns,the nurse cannot be sure about the source of his anxiety.Asking for the records can display a lack of respect by implying that the patient is an unreliable source for information.Stating that the nurse is not sure what the patient means is vague,leaving the patient to guess what the nurse wants to know.

Question 19

A male patient with a history of violence directed toward others becomes very excited and agitated during the nurse's interview.Which intervention should the nurse implement to foster therapeutic communication?

Accepted Answer

The nurse should use neutralizing skills and assume an open,nonthreatening posture that conveys respect and acceptance,creating an atmosphere in which the patient can communicate without feeling threatened or defensive.Depending on the extent of this nurse-patient relationship,the patient can be posturing as they get to know one another; however,before entering the room in the future,the nurse should plan for personal safety by keeping the door open and letting others know that he or she is with the potentially violent patient.Calling security in the patient's presence is likely to aggravate the patient and escalate the potential for violence because it is humiliating,conveys the nurse's rejection of the patient,and threatens to take all control away from him.Asking the patient if he will use self-control is reprimanding him,humiliating,and conveys rejection and lack of respect by the nurse.The patient can perceive leaning and touching as threatening.

Question 20

The nurse admits a patient who is complaining of severe abdominal pain and vomiting who is nonverbal.What can the nurse do to communicate effectively with the patient?

Accepted Answer

Patients with sensory losses require communication techniques that maximize existing sensory and motor functions.Some patients are unable to speak because of physical or neurological alterations such as paralysis; a tube in the trachea to facilitate breathing; or a stroke resulting in aphasia,difficulty understanding,or verbalizing.Many types of communication aids are available for use,including writing boards,flash cards,and picture boards.The nurse needs to determine what will work for the patient.Waiting for family is unacceptable because the patient is in pain.Interpreter services are for patients who do not speak the language.The nurse should not just treat the pain without assessing the patient.

Quiz 2: Communication and Collaboration