Deck 38: Communication

Question 1

A nurse educator is teaching a group of students about therapeutic touch.In which situation is it appropriate to use therapeutic touch as a means of communication?

A) When a family member is making inappropriate comments to the nurse.
B) When an upset spouse is alone and the client has just expired.
C) It is never appropriate in the nursing profession.
D) When a young male client asks a young student nurse for a hug.

Answer 1

When an upset spouse is alone and the client has just expired.

Question 2

The nurse is providing care to a visually impaired client who is scheduled for a colonoscopy.The client requires a bowel prep prior to the diagnostic test.Which approach will the nurse use to facilitate the client's understanding of the material?

A) Use layman's term and ask the client to describe the procedure afterwards.
B) Explanation the procedure to the client using medical terms for clarity.
C) Focus on intonation when teaching the client.
D) Speak slowly to the client.

Answer 2

Use layman's term and ask the client to describe the procedure afterwards.

Question 3

A female nurse is caring for a 21-year-old male client with a questionable gastrointestinal blockage.The healthcare provider prescribes an enema.Which reaction by the client does the nurse anticipate when planning care?

A) "May I have a visitor as support in the room?"
B) "I would rather have my doctor perform this procedure."
C) "I have never had an enema before."
D) "I am afraid of having an enema."

Answer 3

"I would rather have my doctor perform this procedure."

Question 4

The nurse is starting preoperative teaching when the client receives a phone call.When the nurse resumes teaching,the client is visibly upset and begins to cry.Which therapeutic initial response by the nurse is appropriate?

A) "Whatever is upsetting you can be dealt with once we have finished."
B) "It is very important to focus on this teaching so that you will recover quickly after surgery."
C) "I can see the phone call has upset you. Let's talk about why you are upset before we move on with teaching."
D) "What can you do to solve the problem?"

Question 5

The nurse is sitting in on an Alcoholic Anonymous (AA)meeting clients on a behavioral health unit.Which decision-making methods used by the group indicates the group is functioning effectively? Select all that apply.

A) The expertise of group members is being used.
B) The group atmosphere is positive.
C) Members feel satisfied with their participation.
D) The group listens to the ideas of certain group members.
E) The discussion focuses on all problems brought by group members.

Question 6

The nurse completes a teaching session on wound care for a client who will require dressing changes after discharge.The nurse evaluates the effectiveness of a teaching session for wound care with the family and determines that more education is required.Which statement by the nurse is appropriate in this situation?

A) "Let me clarify again some of the steps that are required during wound care."
B) "You did not pay attention, did you?"
C) "Here, let me do it for you."
D) "I do not think you understood me correctly the first time."

Question 7

A young adolescent client is in the hospital preparing for major surgery for the removal of a tumor on the kidney.The client's mother tells the nurse that she doesn't want the child to receive narcotics for pain postoperatively.Which is the best response by the nurse?

A) "Okay, I'll tell the healthcare provider not to order any. Are you sure you want to do this?"
B) "The pain will be severe. Why don't we ask your child about this?"
C) "The pain for your child will be severe after surgery. Can you tell me why you feel this way?"
D) "You do not have a choice of medication. Decisions involving pain relief are up to the healthcare providers."

Question 8

The nurse is caring for a client with cancer who is struggling with chronic pain.The nurse tells the client,"It is normal to feel frustrated about the discomfort." Which skill associated with the working phase of the nurse-client relationship does the nurse's statement best reflect?

A) Confronting
B) Respect
C) Concreteness
D) Genuineness

Question 9

Whether in the classroom or clinical setting,the way a group functions,communicates,sets goals,and achieves objectives is related to which concept?

A) Cohesiveness
B) Group dynamics
C) Commitment
D) Member behavior
E) Power

Question 10

A novice nurse is working with a client who is admitted to a medical-surgical unit.The nurse is establishing a therapeutic relationship with the client by conveying empathy.Which statement by the nurse best exemplifies empathy?

A) "I wouldn't be afraid, if I were you."
B) "You shouldn't have done it that way."
C) "You seem to be frightened by the procedure. Tell me how you are feeling."
D) "I know just how you feel, as my mother has the same illness."

Question 11

The nurse is providing teaching for an inpatient lupus support group meeting.Which group behaviors indicate the teaching was effective?

A) The group members appear relaxed and interested in the topic.
B) Group members are tentative in expressing feelings to the group.
C) The group avoids discussion about lupus signs and symptoms.
D) The group appears self-conscious when asked questions about lupus.

Question 12

The nurse is caring for a client who is having difficulty understanding the wound care dressing changes that need to be completed in the home after discharge.The client asks the nurse to demonstrate the procedure again and allow the client's spouse to perform the procedure while the nurse watches.Which is the most likely outcome of this assertive request by the client?

A) A slightly increased chance that the wound will become infected due to exposure during dressing changes.
B) Less compassionate care for the client due to the spouse's irritation by the request.
C) A greater likelihood that the wound will heal appropriately.
D) A guarantee that the spouse will change the dressings correctly.

Question 13

The nurse is developing objectives for a charter group of nurses from a national association.Which characteristics best describe the semiformal level of formality the nurse can expect when working with this type of group?

A) The structure is formal, with voluntary, selective membership and structured activities during meeting times.
B) The structure is formal, with structured activities, leadership selection from above, and easily recognized basic objectives.
C) The structure is informal, with voluntary, selective membership and negotiable day-to-day operating standards.
D) The structure is informal, with superimposed rules and managers who are symbols of authority.

Question 14

A nurse is providing care for a nonverbal client.The nurse wants to implement strategies that will promote communication with this client.Which interventions would be appropriate for the client in this situation? Select all that apply.

A) Facing the client when speaking
B) Having pen and paper on hand for the client
C) Making sure that the language spoken is the client's dominant language
D) Using a picture board to facilitate communication
E) Employing an interpreter

Question 15

The nurse is caring for an older adult client in a long-term care facility.Which behavior by the nurse convey physical attending when communicating with this client?

A) Facilitating and taking action when needed
B) Maintaining a proper social distance when speaking with the client
C) Leaning toward the client during conversation
D) Being concrete about actions that need to be taken during client care

Question 16

The nurse is caring for a client with a new colostomy.The client has been taught care and has been successful with return demonstration to the staff.Although the client is able to perform care independently,and has asked to do so,the charge nurse has instructed the nursing staff to continue performing colostomy care for this client.When addressing this issue directly with the charge nurse,which statement by the nurse is the most appropriate?

A) "The client will change the apparatus whether you like it or not."
B) "The client has been trained to change the apparatus and has expressed interest to continue doing so."
C) "You have no right to continue delegating this task to nursing when the client has been trained to change the apparatus."
D) "I will report you to the nurse manager for not allowing the client to change the apparatus independently."

Question 17

The nurse is caring for a young adult client after a cervical biopsy.The client has expressed anxiety about the results.The healthcare provider peeks into the client's room and says,"The biopsy is negative." The nurse later finds the client sobbing.Which response by the nurse is appropriate?

A) "What did the healthcare provider tell you about the biopsy?"
B) "You seem upset. Do you want to talk to me about the test results?"
C) "Why are you crying with such good news?"
D) "The term 'negative' in this case is good!"

Question 18

The nurse is providing care for a client who is about to be discharged.The nurse is discussing the discharge orders with the client's primary healthcare provider.Which statement by the nurse is an appropriate example of using assertive communication?

A) "Can we talk about this client prior to discharge?"
B) "That new medication you prescribed for the client is ineffective."
C) "I am worried about the client's blood pressure. It remains high even with the new medication."
D) "Excuse me, Doctor, I think you need to do something about the client's blood pressure."

Question 19

A home health nurse is precepting a new nurse during a routine wound care visit.The new nurse is assessing the client's wound and notes that the wound is showing signs and symptoms of infection.The client's spouse asks the new nurse how the wound looks.The new nurse responds by stating,"It looks fine," but the new nurse's face indicates a different story.When evaluating the new nurse,the preceptor should note that work is needed on which aspect of communication?

A) Credibility
B) Adaptability
C) Timing and relevance
D) Clarity and brevity

Question 20

The nurse case manager spends the morning in a peer meeting and the afternoon in an ad hoc quality management committee meeting that is led by the hospital administrator.Which two types of groups has the nurse case manager participated in?

A) Disaster group and emergency group
B) Work group and administrative group
C) Primary and secondary groups
D) Support group and governance group

Question 21

The nurse is providing care for a client who is newly diagnosed with chronic obstructive pulmonary disease (COPD).Which action by the nurse conveys therapeutic communication with the client?

A) The nurse asks appropriate questions about the client's medical history.
B) The nurse closes the conversation with an anecdote about breathing.
C) The nurse plans to tell the client about a COPD support group.
D) The nurse bonds with the client by describing her life living with COPD.

Question 22

The nurse educator is teaching a group of nursing students about the purpose of documentation and medical records.Which purpose is appropriate for the educator to include in the teaching session with the students?

A) Communication
B) Planning
C) Auditing
D) Research

Question 23

The nurse on third shift is handing off clients to the nurse on first shift.Which key element is most important for the third shift nurse to report during this handoff?

A) The nurse reports, "The client in room 312 continues to complain about a headache unrelieved by pain medication. I am awaiting a call from the physician for orders."
B) The nurse reports on the clients in no apparent order of acuity or room number.
C) The nurse reports, "The client in room 315 received an enema at 2100."
D) The nurse reports, "The client in room 311 was transferred from 212."

Question 24

A new nurse on a unit asks to speak to the nurse manager as several clients have complained because family members were able to hear the verbal report outside the room during nursing rounds.The nurse manager asks the nurse for suggestions that could enhance client privacy.Which suggestion by the new nurse is appropriate?

A) Nursing rounds should take place in each client's room.
B) The unit should be closed to family and visitors during rounds.
C) Nurses should tape-record their reports outside the room.
D) Clients should be allowed to choose whether a written or oral report is used.

Question 25

The nurse is caring for a school-age client who is scheduled to have major heart surgery the next morning.The nurse enters the room to administer a medication and finds the client crying.Which response by the nurse is most therapeutic?

A) "Would you like some toys from the playroom?"
B) "I'm going to go get the doctor."
C) "You shouldn't cry. You are not in pain."
D) "It is okay to cry. I know this is scary."

Question 26

The nurse is preparing to document care provided to the client during the day shift.The nurse documents that the client experienced an increased pain level while ambulating which required an extra dose of pain medication; took a shower; visited with family; and ate a small lunch.Which information is important to include during the oral end-of-shift reporting? Select all that apply.

A) The extra dose of pain medication
B) The client's visit with family
C) The client's response to ambulation
D) The last antibiotics given
E) The client's taking a shower

Question 27

A nurse manager is working with staff nurses regarding the types and frequency of documentation required for clients being cared for in long-term care facilities.Which laws contribute to the specific documentation required for client's in long-term care facilities? Select all that apply.

A) Kardex
B) Omnibus Budget Reconciliation Act (OBRA)
C) Health Care Financing Administration Act
D) Minimum Data Set (MDS)
E) Charting by exception (CBE)

Question 28

The nurse is providing care to a client who is diagnosed with hypertension.Which response by the nurse is an appropriate example of informational confrontation with the client?

A) "I noticed you rubbing your head and your eyes, are you hurting? Let's take your blood pressure."
B) "I heard raised voices when I was coming down the hall to your room. Are you upset?"
C) "It is 3 p.m. and time to take your blood pressure before I give you your medication."
D) "Is the blood pressure medication making your head hurt?"

Question 29

The nurse is providing care to a client who is newly diagnosed with human immunodeficiency virus (HIV).Which statements by the nurse could inhibit the development of a therapeutic communication with this client? Select all that apply.

A) "I am so happy today! I found out that I got accepted into nurse practitioner school, isn't that great?"
B) "Well, I guess your homosexual lifestyle finally caught up to you, huh?"
C) "One of my cousins has AIDS. It is hard to watch him die."
D) "Tell me your feelings about the diagnosis."
E) "Perhaps you would like to talk about the new medications that you have been prescribed?"

Question 30

The nurse is assigned to provide care to a client who is diagnosed with chronic obstructive pulmonary disease (COPD).Overnight,the client's oxygen saturation levels decreased and the client was placed on oxygen by the respiratory therapist.To review specific information about the care received from the respiratory therapist,which portion of the medical record will the nurse review?

A) The consultation report
B) The nurses' notes
C) The medication record
D) The diagnostic report

Question 31

The clinic nurse is faxing a client's medical record to the local hospital.Which actions by the nurse are appropriate to ensure the client's confidentiality is maintained? Select all that apply.

A) Using a fax cover sheet
B) Having signed client consent from the client
C) Conducting a check of the fax number prior to transmitting
D) Including identifiable client information on the cover sheet
E) Signing an employee consent form

Question 32

Handoff communication,the transfer of information during transitions in care such as during change-of-shift reports,includes an opportunity to ask questions,clarify,and confirm the information between sender and receiver.Which is the main objective for ensuring effective communication during a client handoff?

A) To avoid lawsuits
B) To make sure all documentation is done
C) To facilitate quality improvement
D) To ensure client safety

Question 33

A novice nurse asks the preceptor why the staff spends time talking about the clients between shifts when the oncoming nurses can read the charts instead.Which is the best response by the preceptor?

A) "Maybe we should suggest primary nursing."
B) "Change-of-shift report ensures that the oncoming staff knows the most critical information about the client requiring care."
C) "It has always been done this way."
D) "You are right. It is a waste of time."

Question 34

The nurse is documenting care in the medical record.The nurse provides narrative documentation only for abnormal assessment findings.Which type of charting is the nurse using based on this example?

A) Computerized documentation
B) Charting by exception (CBE)
C) SOAP charting
D) Focus charting

Question 35

The healthcare provider prescribes digoxin for a client who is to be discharged in the morning.When documenting the order in the medical record,which action by the nurse is the most appropriate?

A) Write digoxin, .0125 mg QD
B) Write digoxin, 0.0125 mg QD PO
C) Write digoxin, 0.0125 mg, once daily.
D) Write digoxin, 1 pill each day.

Question 36

A nurse has just been hired as a medical information system (MIS)trainer at a hospital where an electronic medical record is being installed.The nurse has been asked to assess the security of the client's medical records.According to the Security Rule of HIPAA,which recommendations by the nurse will enhance security? Select all that apply.

A) Assign each staff member a unique username and password.
B) Install a firewall.
C) Store computer-generated materials in a locked vault.
D) Turn monitors away from view when unattended.
E) Assign each unit unique passwords.

Question 37

The nurse is caring for a client who received analgesic medication via central line to treat pain associated with cancer.After reassessing the client's response,which section of PIE will the nurse use when documenting the client's care?

A) Evaluation
B) Progress notes
C) Problem
D) Intervention

Question 38

The nurse is conducting a health history on a client who is being admitted to a medical-surgical unit for the treatment of chronic pain.The client is concerned about privacy and asks why it is necessary for the nurse to ask for private information and then document it in the medical record.Which response by the nurse is most appropriate?

A) "You will be able to read the record and review your care."
B) "Documentation decreases the likelihood that you will have to repeat this information to others who will care for you."
C) "Your family can review the record and ensure that care is appropriate."
D) "A record ensures there are no breaches of confidentiality."

Question 39

The nurse is preparing to provide care for a client who is newly admitted to the unit.Prior to assessing the client,which should the nurse review to determine care that may be needed?

A) The written care plan
B) The client's medical record
C) The Kardex
D) The medication administration record (MAR)

Question 40

The nurse is caring for a client who is reporting pain of 8/10 on a 1 to 10 numeric pain scale.The nurse administers the prescribed pain medication.When the nurse re-evaluates the client one hour later,the client is still reporting pain of 8/10.Which action by the nurse is appropriate at this time?

A) Wait for the healthcare provider to make rounds to report the problem.
B) Report to the healthcare provider by telephone.
C) Increase the dosage of the medication.
D) Include in the nursing report that the medication is ineffective.

Question 41

When the nurse receives a telephone order from the healthcare provider's office,which guidelines are used to ensure the order is correct? Select all that apply.

A) Ask the prescriber to repeat or spell out medication.
B) Read the order back to the prescriber.
C) Ask the prescriber to speak slowly.
D) Know agency policy for telephone orders.
E) Sign the prescriber's name and credentials.

Question 42

The nurse is providing care to a client diagnosed with end-stage renal disease.When planning a care plan conference for this client,who does the nurse invite to participate?

A) Family members
B) The psychiatrist
C) The oncologist
D) The hospital CEO