Question 1

An experienced nurse is telling a recent graduate nurse that engaging in active listening with patients can be very tiring because:
A) developing the skills needed for active listening takes time and effort.
B) it is difficult to stay quiet and let the patients do all the talking.
C) it requires actively examining the content of what the patient says.
D) more time is required to engage in active listening with patients.

Accepted Answer

Active listening is an active, not a passive, process and involves working to understand the words and the meanings behind what the patient is saying.It does take some effort to develop this skill, but this is not the best explanation of the issue.It is difficult for some people to use silence in conversation, but this is not the reason active listening can be tiring.It is debatable whether more time is required to engage in active listening with patients.

Question 2

A nurse talking with a patient about a new diagnosis of advanced cancer wishes to encourage the patient to continue speaking without asking direct questions.The patient has not decided whether to have treatment or go on hospice.Which statement by the nurse would best accomplish this goal?
A) "My brother had the same thing, and he did well with treatment."
B) "So you are not sure if you want to try the treatment or not."
C) "Tell me more about what you are thinking about your options."
D) "Uh huh, I see you are having a conflict about having treatment."

Accepted Answer

In restatement, the nurse repeats what the patient just said, either verbatim or paraphrased.The goal is to let the patient know the nurse is listening and to encourage elaboration.Telling the patient about a family member's experience with cancer is an example of inappropriate self-disclosure and might make the patient feel as if his or her own feelings were not as important.Asking the patient to further explain what has just been said is an example of clarification, which helps ensure the message received is the one that was sent.Although useful, this is not the best choice in this situation."Uh huh, I see you are having a conflict about having treatment" sounds patronizing and would most likely make the patient feel as if he or she is not really being listened to because the nurse is deciding what the patient meant.

Question 3

The nurse knows that reframing is a useful technique when the patient:
A) cannot articulate fears embedded in the conversation.
B) is confused and unable to articulate his or her concerns.
C) pauses the conversation, letting the nurse summarize.
D) uses absolutely concrete verbiage such as "never."

Accepted Answer

When patients use such black-and-white words as "always" or "never," reframing helps them put things into perspective.When a patient cannot articulate fears, reflection is an appropriate technique.When a patient is confused and unable to articulate concerns, clarification may be useful, with the nurse validating what the patient is trying to say.When a patient pauses the conversation, summarization is beneficial to provide a short synopsis of the conversation so that both parties can review it.

Question 4

A new nurse is friendly and talkative and often tells her patients about her personal life as a way to make friends with them.The manager is counseling her because of recent complaints from these patients that she is unprofessional.Which statement by the manager best summarizes the problem?
A) "Be careful about sharing information; patients can use it against you."
B) "It is unprofessional to divulge any personal information to your patients."
C) "Personal disclosure can be helpful only if it is in the patient's best interest."
D) "You are not here to make friends with patients; you are a professional nurse."

Accepted Answer

Personal information can be shared with patients, but remember that the focus of all professional interactions is the patient; share only that which will be beneficial to the patient.It might be unprofessional to divulge personal information with patients in some cases, but this is not the reason to be cautious about sharing personal information.Selective sharing of personal information can help the nurse and patient bond and might give patients information that helps them resolve an issue.Telling the nurse that he or she is not here to make friends is a very cold response and does not get to the heart of the problem.

Question 5

A faculty member explains to the class that during the working phase of a therapeutic relationship, the nurse:
A) follows the patient's lead on what topics need exploration.
B) needs to establish trust through honesty and commitment.
C) reflects on the professional role and its responsibilities.
D) reviews the patient's status, setting goals for the interaction.

Accepted Answer

During the working phase, as the interaction becomes more focused and intense for both the patient and nurse, the nurse needs to mirror the patient closely and to pursue the topics the patient deems important and that the patient seems ready to work on.Establishing trust is part of the orientation phase.Reflecting on the professional role is part of the orientation phase.Reviewing the patient's status is part of the orientation phase.

Question 6

A nurse and client have been working together for many months, and all goals for their relationship have been met.The nurse notes that the client has cancelled two appointments in a row.In assessing this situation, which statement by the nurse would gather the most important information?
A) "I see you keep cancelling appointments.Is this time inconvenient?"
B) "I'd like to know what you think will happen when you stop seeing me."
C) "Why do you feel uncomfortable talking to me after all this time?"
D) "Would you please explain to me why you keep cancelling appointments?"

Accepted Answer

The termination phase of a working relationship might cause stress, and clients might exhibit behaviors such as anger or even cancelling appointments.The nurse's role is to help the client understand the meaning behind these actions.Asking about one rather superficial issue (appointment times)does not show the client that the nurse is really interested in the client.By guessing at the reason for the client's action (assuming the appointment times are inconvenient), the nurse is limiting the chance for a meaningful interaction."Why" questions are generally not a good idea; they tend to put people on the defensive.Asking for an explanation for cancelled appointments sounds patronizing and authoritarian.

Question 7

A nursing manager is frustrated by a committee that consistently fails to meet goals and generally demonstrates a lack of progress or results.The manager can conclude that:
A) established policies and procedures might be inhibiting productivity.
B) self-serving behaviors outweigh the task behaviors in the group.
C) the committee's goals are vague and the committee lacks direction.
D) the leadership within the group is not skilled at group management.

Accepted Answer

Groups encounter task behaviors, maintenance behaviors, and self-serving behaviors.Whereas the task behaviors push the group toward goal attainment, self-serving behaviors inhibit group work.The manager can conclude that the members in this group exhibit more self-serving behaviors.It is possible that established policies and procedures might be inhibiting productivity, but this is too narrow an answer to explain the situation without further information.Vague goals and lack of direction may be a factor, but without further exploration, this is not the best choice.The leadership within the group may not be skilled at group management, but this conclusion needs further exploration.

Question 8

The student learning about therapeutic communication techniques knows that the most important concept in the definition of communication is:
A) exchanging.
B) messages.
C) receiver.
D) sender.

Accepted Answer

The key word in the definition of communication is "exchanging," which implies a giver and a receiver and an active process.Messages or signals are ways that information is shared.The receiver is the person who gets the message, but this linear process does not account for the dynamic nature of communication.The sender is the person giving the message, but this linear process does not account for the dynamic nature of communication.

Question 9

A nurse is interviewing a woman in the emergency department about injuries the nurse thinks might have been caused by domestic violence.The woman seems hesitant to discuss her injuries.Which action by the nurse would most likely result in improved communication?
A) Ask the woman why she does not want to discuss the injuries.
B) Close the door and assure the woman of confidentiality.
C) Maintain eye contact while jotting down only brief notes.
D) Sit close, lean in to the woman, and use touch liberally.

Accepted Answer

Being in a busy location may make the woman fear being overheard, and assurances of confidentiality will encourage her to talk about this sensitive subject."Why" questions tend to place people on the defensive and are seen as a barrier to effective communication.Maintaining eye contact, if culturally appropriate, is a good idea, but is probably not enough to get this woman to elaborate on her injuries.Writing only brief notes is not a good idea for complete documentation.Sitting close may violate this patient's personal space.Although leaning in conveys interest, touch should be used judiciously.

Question 10

A seasoned nurse and a student are completing an admission history with a patient.On leaving the room and discussing their findings, the novice nurse is stunned that what the seasoned nurse learned about the patient seems so different from what he or she took from the interview.What explanation by the seasoned nurse best illustrates the dynamics of this interaction?
A) Experience facilitates selective attention and helps create reality for seasoned nurses.
B) Nurses working on one floor see similar patients and learn how to focus the questions.
C) The novice nurse simply does not know the most important questions to ask patients.
D) The novice nurse was focusing on asking all the questions on the admission database.

Accepted Answer

Experience teaches the nurse how to selectively pick out the most important messages, and habituation helps block out irrelevant messages.People are able to make sense of the messages they receive, in part, because of their past experience such that present reality is tied to these past experiences.The novice nurse has not yet been able to develop the skills of selective attention and habituation in a health care setting and has little experience to shape his or her understandings.With a specific population, the nurse might be able to focus questions in this manner, but working on one floor consistently does not adequately explain the interaction.The novice nurse may not yet be able to differentiate between important and not-so-important questions, but this explanation is too narrow to fully describe the interaction.Novices do focus on procedures and steps to complete, but this explanation is too narrow to fully explain the interaction.

Question 11

A nurse usually avoids physical contact with patients, but when one is diagnosed with a terminal disease, the nurse wishes to hug the patient.This contradiction initially confuses the nurse, but a co-worker helps the nurse differentiate the two behavioral responses based on:
A) feelings of closeness to this patient.
B) the context in which each occurred.
C) therapeutic communication techniques.
D) values that guided each situation.

Accepted Answer

Context is the biggest influence on the interpretation of communication, and it means more than the place and time in which communication occurred.The nuances and shared meanings that occur in each situation give rise to individually constructed meanings.In the setting of a new terminal diagnosis, the nurse was aware of contextually driven communication needs and responded by wanting to hug the patient.Nurses do become closer to some patients than to others, but this is a very narrow explanation.Touch is part of therapeutic communication, but this is too narrow an explanation.Values are part of all communication encounters, but this is too narrow to explain the appropriateness of the different responses.

Question 12

A nurse explains to a preceptor student that values clarification helps with intrapersonal communication because:
A) communication is enhanced when it occurs between people with similar values.
B) it allows the nurse to separate his or her values from those of the patient.
C) it helps the nurse avoid saying things that might offend or anger others.
D) understanding values will help prevent communication misunderstandings.

Accepted Answer

Engaging in values clarification allows the nurse to separate his or her values from those of the patient; this in turn allows the nurse to truly attend to what the patient is saying.Communication may be more awkward when it is between people of vastly differing value systems, but this would make values clarification more useful and help ease communication tensions.The purpose of values clarification is not to help avoid making offensive statements.Clarity of the message is what will help avoid misunderstandings.

Question 13

A nurse works with victims of sexual abuse.In counseling these individuals, the nurse often elicits information that surprises the client when it is revealed.The nurse describes this situation to a preceptor student as working in the part of the Johari window that is labeled the __________ pane.
A) blind
B) hidden
C) open
D) unknown

Accepted Answer

The unknown pane represents the unconscious element that is not known to either party.This information often is revealed during conversations.The blind pane is the pane of glass that reveals what a person knows about another but is unknown to the self.In the Johari window, the hidden pane is that which is known to the self but not to the other.The open pane is what is visible and known to both the self and to the other.

Question 14

A nurse is discussing an emotional topic with a patient and wants the patient to continue talking but would also like to convey encouragement.Which action by the nurse would best accomplish this?
A) Lean back and keep eye contact.
B) Nod his or her head and say, "Uh huh."
C) Repeat what the patient just said.
D) Say, "I'd like to hear more, please."

Accepted Answer

Nodding the head, making brief positive vocalizations such as "uh huh," or giving short leads such as "go on" are called minimal cues and leads.This and the use of touch show the patient that the nurse is listening and encourage the patient to keep talking.Maintaining eye contact is a good idea, but leaning back in the chair will convey distance.Repeating what the patient just said would not encourage continued talking; rather, it would be seen as a break in the train of thought.Saying, "I'd like to hear more, please" would take longer than necessary and might break the patient's train of thought and end the conversation prematurely.

Question 15

A patient has just made some statements that seem vague and ambiguous to the nurse.The best statement by the nurse after the patient finishes speaking would be,
A) "Are you afraid these tests will bring results that will upset you?"
B) "I'd like to understand more about what happened earlier today."
C) "Why do you think this happened to you today instead of earlier?"
D) "You said earlier that you were upset by the physician on rounds."

Accepted Answer

Saying "I'd like to understand more ..." shows clarification, a technique used when a patient makes vague statements or after the patient finishes a train of thought.Asking whether the patient is afraid to get test results would be an example of reflection, a technique used when a patient does not state his or her underlying feelings.This would not be the best choice in this particular situation.This "why" question is probing and might well put the patient on the defensive, especially if the patient does not understand the feelings behind what is being said."You said earlier that you were upset by the physician on rounds" is an example of restatement.

Question 16

A manager is concerned about the level of gossip and "grapevine" communication on the unit.A management consultant explains to the manager that the "grapevine" often occurs when:
A) little communication comes from management.
B) management is not trusted to divulge information.
C) regular communication is too slow or irregular.
D) workers feel uncertain or worried about changes.

Accepted Answer

Grapevines provide a valued source of information when employees feel threatened, insecure, or are facing organizational changes.Lack of communication is not one of the core reasons grapevines come into being.Distrust of management is not one of the core reasons grapevines exist.Slow or irregular communication is not one of the causative factors for the "grapevine."

Question 17

Why are communication theories that consider only a linear relationship between the sender and receiver of messages considered to be too simplistic?
A) In relationships of unequal power, linear models do not work well.
B) Linear pathways imply both sender and receiver actually participate.
C) Linear models do not consider the dynamic interactions of multiple variables.
D) There are often more than one sender and more than one receiver.

Accepted Answer

Communication is a complex process that incorporates multiple variables, including relationships, past experiences, and personalities.These linear models simplify a process that is very complex and makes static a process that is dynamic.Linear models show communication flowing from a sender to a receiver; whether or not both are active participants is not part of the criteria of linear models, although active participation would create better communication.There may be more than one sender and receiver in a communication exchange, but this would make the theory more, not less, complex.

Question 18

A nurse wishes to have the patient reflect on what the patient has just said.To allow this to happen, the nurse should:
A) ask the patient to reflect on what was just said.
B) clarify the meaning of the words with the patient.
C) repeat what was said and ask what was meant.
D) stay silent until the patient begins to talk again.

Accepted Answer

Silence is an important therapeutic communication technique because it allows time for both the patient and the nurse to reflect on what has been said.This might work with some patients who understand what is being asked of them, but it is not the best answer.Making sure the nurse understands exactly what the patient means is important, but it will not encourage the patient to reflect.Repeating what was said and asking what was meant will not aid the patient in reflection.

Question 19

A new graduate nurse is concerned about the ability to communicate effectively with patients and families.An experienced nurse explains to the new nurse that a good rule of thumb is for the new nurse to:
A) avoid using silence until comfortable with patients.
B) find and use metaphors that are easily understood.
C) mirror patients in actions and depth of conversation.
D) use personal stories to encourage bonding with patients.

Accepted Answer

Mirroring the patient allows the patient to direct the interaction.Follow the patient's leads.Nurses are often uncomfortable with silence, but it is an important therapeutic communication technique and should be used.Practice will make the nurse more comfortable with it.Metaphors can be useful devices but are also often overdone.Personal stories can be a valuable means of opening up conversations, but the nurse must not overuse them and should not share information that has not been resolved.

Question 20

A nurse serves as a preceptor to a new graduate who is taking an admission database from a new patient.Afterward, the preceptor critiques the new graduate's use of "why" questions, stating,
A) "Avoid using 'why' questions because they make people defensive."
B) "Good job.Your 'why' questions were focused and right to the point."
C) "Nice work.Your 'why' questions were clear and very understandable."
D) "Try using other kinds of questions because 'why' questions get monotonous."

Accepted Answer

"Why" questions are not useful because they ask people to explain things.The person might not understand the rationale behind this and may become defensive.The questions might have been focused, but "why" questions are not considered a good communication technique.The questions may have been clear and understandable, but "why" questions are not considered a good technique; they can put people on the defensive."Try using other kinds of questions because they get monotonous" would not be a relevant critique of "why" questions.

Quiz 8: Effective Communication

An experienced nurse is telling a recent graduate nurse that engaging in active listening with patients can be very tiring because:

A nurse talking with a patient about a new diagnosis of advanced cancer wishes to encourage the patient to continue speaking without asking direct questions.The patient has not decided whether to have treatment or go on hospice.Which statement by the nurse would best accomplish this goal?

The nurse knows that reframing is a useful technique when the patient:

A new nurse is friendly and talkative and often tells her patients about her personal life as a way to make friends with them.The manager is counseling her because of recent complaints from these patients that she is unprofessional.Which statement by the manager best summarizes the problem?

A faculty member explains to the class that during the working phase of a therapeutic relationship, the nurse:

A nurse and client have been working together for many months, and all goals for their relationship have been met.The nurse notes that the client has cancelled two appointments in a row.In assessing this situation, which statement by the nurse would gather the most important information?

A nursing manager is frustrated by a committee that consistently fails to meet goals and generally demonstrates a lack of progress or results.The manager can conclude that:

The student learning about therapeutic communication techniques knows that the most important concept in the definition of communication is:

A nurse is interviewing a woman in the emergency department about injuries the nurse thinks might have been caused by domestic violence.The woman seems hesitant to discuss her injuries.Which action by the nurse would most likely result in improved communication?

A nurse usually avoids physical contact with patients, but when one is diagnosed with a terminal disease, the nurse wishes to hug the patient.This contradiction initially confuses the nurse, but a co-worker helps the nurse differentiate the two behavioral responses based on:

A nurse explains to a preceptor student that values clarification helps with intrapersonal communication because:

A nurse works with victims of sexual abuse.In counseling these individuals, the nurse often elicits information that surprises the client when it is revealed.The nurse describes this situation to a preceptor student as working in the part of the Johari window that is labeled the __________ pane.

A nurse is discussing an emotional topic with a patient and wants the patient to continue talking but would also like to convey encouragement.Which action by the nurse would best accomplish this?

A patient has just made some statements that seem vague and ambiguous to the nurse.The best statement by the nurse after the patient finishes speaking would be,

A manager is concerned about the level of gossip and "grapevine" communication on the unit.A management consultant explains to the manager that the "grapevine" often occurs when:

Why are communication theories that consider only a linear relationship between the sender and receiver of messages considered to be too simplistic?

A nurse wishes to have the patient reflect on what the patient has just said.To allow this to happen, the nurse should:

A new graduate nurse is concerned about the ability to communicate effectively with patients and families.An experienced nurse explains to the new nurse that a good rule of thumb is for the new nurse to:

A nurse serves as a preceptor to a new graduate who is taking an admission database from a new patient.Afterward, the preceptor critiques the new graduate's use of "why" questions, stating,