Question 1

The nurse asks a newly admitted patient, "Can you tell me what brought you to the hospital today?" The purpose of an open-ended question is to

Accepted Answer

Open-ended questions are defined as questions that are open to interpretation, and cannot be answered by "yes, or no," or a one-word response. They allow patients to express their problems or health needs, in their own words. Open-ended questions usually begin with words such as "what," "how," "or," "can you describe for me…," etc. They provide a broader context for each patient's unique health concerns and are likely to yield more complete information. Open-ended questions invite patients to think and reflect on their situation. They help connect relevant elements of the patient's experience.

Question 2

When communicating with a patient, the nurse recognizes that a barrier to effective communication is

Accepted Answer

Barriers within the nurse occur when the nurse is not fully engaged with the patient due to preoccupation with personal agendas; being in a hurry to complete physical care; making assumptions about patient motivations; cultural stereotypes; defensiveness or insecurity about helping the patient; thinking ahead to the next question; intense patient emotion/aggressiveness; or weak language that doesn't add value to the conversation.

Question 3

The student nurse is working on an assignment in which she has to interview a fellow student nurse for 30 minutes. The fellow student nurse talks about career plans, possible jobs after graduation, and her part-time work. After 10 minutes, she has stopped talking and both student nurses sit in silence. Which of the following is the best response by the interviewing student nurse?

Accepted Answer

Open-ended questions are defined as questions that are open to interpretation, and cannot be answered by "yes, or no," or a one-word response. They allow patients to express their problems or health needs, in their own words. Open-ended questions usually begin with words such as "what," "how, "or, "can you describe for me…" etc. They provide a broader context for each patient's unique health concerns and are likely to yield more complete information. Open-ended questions invite patients to think and reflect on their situation. They help connect relevant elements of the patient's experience. Asking a focused question allows the interviewer to obtain more specific information. "Who is the most significant person in your life" is a closed-ended question that is limiting. A silent pause can be helpful, but long silences can become uncomfortable.

Question 4

When caring for a hospitalized patient, the nurse demonstrates effective communication when

Accepted Answer

When making verbal responses or providing information, do not overload the patient with too many ideas, or details. If you find you are doing most of the talking, you need to back up and use listening responses to elicit the patient's perspective. It is important to give the patient honest feedback, but to do so while letting the patient modify the direction in a win-win situation that are negotiated with shared goals to whatever extent is possible. People can absorb only so much information at one time, particularly if they are tired, fearful, or discouraged. Introducing new ideas one at a time allows the patient to more easily process data. Repeating key ideas and reinforcing information with concrete examples facilitates understanding and provides an additional opportunity for the patient to ask questions.

Question 5

When teaching a patient how to administer insulin, the nurse recognizes that the best method of communicating therapeutically with the patient is to

Accepted Answer

Privacy, space, and timing affect therapeutic conversations. Patients need privacy, free from interruption, and environmental noise for meaningful dialogue to take place. "Noise" refers to any distraction, which interferes with being able to pay full attention to the discussion. Also, people require different amounts of personal space for conversation. Therapeutic conversations typically take place within a social distance (3-4 feet is optimal). Culture, personal preference, nature of the relationship, and the topic will influence personal space needs.

Question 6

The nurse demonstrates understanding of the concept of metacommunication through

Accepted Answer

Included with each verbal message are important nonverbal instructions (metacommunication) about how to interpret the message (see Chapter 6). If a nurse sits down in a relaxed position with full attention and good eye contact and actively listens, these verbal and nonverbal activities indicate interest and commitment.

Question 7

As the nurse communicates with a patient, the feedback provided by the nurse should be

Accepted Answer

Feedback loops (from the receiver, or the environment), provide information about the output as it relates to the data received, and/or acted upon. This feedback either validates the received data, or reflects a need to correct/modify original input information. Thus, transactional models draw attention to communication as being relational, and having purpose, and meaning-making attributes. Figure 5.1 displays the elements of transactional models.

Question 8

A nurse is conducting a medication education group for mentally ill patients. One of the patients states, "I don't think everyone needs medications. What about psychotherapy? Can you tell me about that?" What is an appropriate response by the nurse?

Accepted Answer

In today's health care delivery system, nurses must make every second count. It is important for nurses and patients to select the most pressing or relevant health care topics for discussion.
Sensitivity to patient need and preferences should be factors to take into consideration. You should not force a patient to focus on an issue that he or she is not yet willing to discuss unless it is an emergency situation. You can always go back to a topic when the patient is more receptive.

Question 9

Which of the following is the best questioning sequence during a patient interview in which the patient is communicative and not in an emergency situation?

Accepted Answer

Start with open-ended questions to allow the patient to tell his or her story in his or her own way to obtain general information. Use focused questions to obtain more specific information Start with open-ended, not focused or closed, questions. Proceed to focused questions, not closed questions.

Question 10

Which of the following is true in relation to the use of humor?

Accepted Answer

Humor and laughter have healing purposes. Laughter generates energy, and activates b-endorphins, a neurotransmitter that creates natural highs and reduces stress hormones. Humor is most effective when rapport is well established and a level of trust exists between the nurse and patient. When humor is used, it should focus on the idea, event, or situation, or something other than the patient's personal characteristics. Humor should fit the situation, not dominate it.

Question 11

A patient tells the nurse, "I am having a tough time and I am scared about the future." Which of the following responses by the nurse is the best feedback?

Accepted Answer

Reflection is an active listening response, which focuses on the emotional part of a message. It offers nurses a way to empathetically mirror their sense of how a patient may be emotionally experiencing their health situation. A reflective listening response should be a simple observational comment, expressed tentatively, not an exhaustive comment about the patient's emotional reaction. It offers an opportunity for the patient to validate or to change the narrative. When reflecting on an emotional observation, students sometimes feel they are putting words into the patient's mouth when they "choose" an emotion from their perception of a patient's message. This would be true if you were choosing an emotion out of thin air, but not when you empathetically mirror what you are hearing from the patient. as the patient simply present potential or observable be the underlying feelings present in the patient's narrative, without interpreting its meaning.

Question 12

When conducting an assessment interview, which of the following is the best communication technique for the nurse to use?

Accepted Answer

A patient-centered interview begins with encouraging patients to tell their story in an authentic way (Platt & Gaspar, 2001). Open ended questions are a major means of helping patients tell their story, obtaining relevant information, and reducing misunderstandings. There are different ways of asking questions. Questions fall into three categories: open ended, closed ended, and circular. Nonverbal signals transmitted through body action (smiling, nodding, and leaning forward, encourage patients to continue their story). Short phrases such as "Go on" or "And then?" or "Can you say more about… ?" are useful verbal prompts.

Question 13

A patient states, "I don't know about taking this medicine the doctor is putting me on. I've never had to take medication before, and now I have to take it twice a day." The nurse's response is, "It sounds like you don't know what to expect from taking the medication." The nurse's response is an example of which of the following?

Accepted Answer

Paraphrasing is a listening response used to check whether the nurse's translation of the patient's words represent an accurate interpretation of the message. The strategy involves the nurse taking the patient's original message and transforming it into his or her own words, without losing the meaning. A paraphrase should be shorter and more specific than the patient's initial statement so that the focus is on the core elements of the original statement. Your objective in using paraphrasing as an active listening response is to find a common understanding of issues important to your patients. Paraphrasing allows you to summarize or streamline a message, and/or highlight key points of the longer message.

Question 14

A patient states, "I can't sleep all night because the nurses are noisy." Which of the following responses by the nurse best represents the nurse's recognition of the patient's theme?

Accepted Answer

A nurse should listen for patient-centered conversations. Behind the actual words exist themes, which refer to the underlying message, present, but not identified in the patient's words. Listening for themes requires observing and understanding what he patient is not saying, as well as what the person actually reveals through words. Speaking to a supervisor, explaining that nurses communicate with other patients during the night, and telling the night nurse of the complaint are actions by the nurse, not identification of themes.

Question 15

When communicating with patients, the nurse actively uses listening responses. Which of the following types of listening response should the nurse use?

Accepted Answer

Paraphrasing is a listening response used to check whether the nurse's translation of the patient's words represent an accurate interpretation of the message. The strategy involves the nurse taking the patient's original message and transforming it into his or her own words, without losing the meaning. Moralizing, giving advice, and false reassurances are all examples of negative listening responses.

Question 16

When therapeutically communicating with a patient who has just found out he is HIV-positive, the nurse should focus on

Accepted Answer

Therapeutic communication, a term introduced by Jurgen Ruesch in 1961, refers to a dynamic interactive process entered into by health care providers, with their patients and significant others, for the purpose of achieving identified health-related goals. Therapeutic communication occurs in a variety of ways-through words, facial expressions, body language, e-mail, writing, and behaviors.

Question 17

A patient is admitted to the hospital for unsteady gait resulting in frequent falls. Which of the following is a circular question that the nurse could ask this patient?

Accepted Answer

Circular questions are a form of focused questions that look at how other people within the patient's support circle respond to a patient's health issues. These questions are designed to identify differences in the impact of an illness on individual family members, and to explore changes in relationship brought about by the health circumstances.

Question 18

The nurse enters a patient's room with the intent of allowing the patient to express feelings in relation to her new cancer diagnosis. The nurse notices that the patient is crying and guarding her incision site. After validating physical discomfort, the nurse should

Accepted Answer

The presence of pain or variations in energy levels, anger, or anxiety will require extra time to inquire about the change in the patient's behavior and its meaning, before proceeding with the health care dialogue. Barriers to effective communication include preoccupation with pain, physical discomfort, worry, or contradictory personal beliefs; inability to understand the nurse's use of language, terminology, or frame of reference; struggling with an emotion-laden topic; feeling defensive, insecure, or judged; confused by the complexity of a message; lack of privacy; and sensory or cognitive deficits.

Quiz 5: Developing Patient-Centered Communication Skills