Question 1

The nursing student addresses an 86-year-old patient by his first name at their initial meeting. To the patient, this behavior

Accepted Answer

Addressing an older adult by his first name by the nursing student may be interpreted as a lack of respect. Regarding therapeutic communication, positive regard implies respect and a willingness to work with the patient and communicate (through your actions) that the patient is a person worthy of caring about. Empathy is the ability to perceive the patient's needs, feelings, and situation accurately. Focus on the student nurse is incorrectly directed with the answer choices that discuss the student nurse's feeling comfortable working with the patient and the student nurse's establishing boundaries for the nurse-patient relationship.

Question 2

The nurse is working in the outpatient clinic when a patient who has been waiting to be seen for an hour yells, "What are you people doing? I'm sick and tired of waiting!" Which response is the most therapeutic, if made by the nurse?

Accepted Answer

Acknowledging the patient's frustration with "I can see that you are frustrated" indicates that the nurse is listening and that the message has been received. Stating "The doctor can only do so much" is defensive and minimizes the patient's issue. Asking "Would you like a magazine?" is a change of subject that discounts the patient's feelings and is likely to irritate the patient further. Stating "You need to be quiet!" shows a total disregard for the patient's frustration.

Question 3

Laura, a nurse manager, is meeting with the staff, which consists of nurses from the Veteran, Baby Boomer, Generation X, and Millennial generations. Which of the following is the best approach to encouraging collaboration and feedback from everyone?

Accepted Answer

Forming a committee made up of representatives from each generation is more likely to result in more collaborative and meaningful discussions. Asking for volunteers to form a committee would likely result in one generation being primarily represented and does not encourage collaboration among the generations. Forming a committee of experienced, older nurses, discriminates against other generations and experience. Meeting with each nurse does not encourage collaboration because it does not allow staff members to interact.

Question 4

The nurse is caring for a 64-year-old woman 4 hours after knee replacement. Although she rates her pain at 6 out of 10, she refuses pain medication and tells the nurse, "I can deal with it." Which of the following is the nurse's best response?

Accepted Answer

Encouraging the patient to talk about her concerns is the most therapeutic response in order to determine the reason for the refusal of pain medication. The comments, "OK, that's your decision" and "You're just being stubborn" are judgments and not therapeutic statements. The comment "OK, I'll come back later" is not an appropriate response in this case because nothing is done to relieve the patient's pain.

Question 5

When considering the creation of an environment for emotional support in a therapeutic relationship, the primary focus of the nurse should be

Accepted Answer

Establishing trust is a primary activity of the therapeutic relationship. The nurse must project warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family. Removing stressors, encouraging independence, and allowing the patient to be in control of medical decision-making are not therapeutic communication facilitators.

Question 6

When preparing for patient teaching what should the nurse do first?

Accepted Answer

The principles of teaching and learning should be applied to make an accurate assessment of learning needs and evaluate the effectiveness of the teaching provided. Listing key points, collecting teaching materials, and thinking about how a skill can be done at home are all considerations after learning needs are assessed.

Question 7

The nurse is preparing to assess a newly admitted Chinese patient. Which of the following would be most appropriate to assess first?

Accepted Answer

The nurse must first assess the ability to communicate with the patient before pain, family support, or religious preference can be assessed.

Question 8

A nurse has a plan for teaching the patient about a newly diagnosed disease. On entering the room the nurse realizes that the patient is blind. What considerations for communication should the nurse be aware of?

Accepted Answer

Communication is the interaction between two or more individuals in which an exchange of information occurs. How we communicate is as important as what we communicate. For instance, tone, pitch, inflection, and intensity of how we speak affect how messages are communicated. Tone, pitch, inflection, and intensity are examples of nonverbal communication and affect how messages are communicated. Messages are clearer when verbal communication and nonverbal cues are agreeable. Nonverbal communication must be understood within the context of a patient's culture, gender, and age. Facial expressions, personal appearance, eye contact, eye cast, and physical characteristics are examples of nonverbal communication.

Question 9

A patient scheduled for surgery has a severe level of anxiety. Which action, if taken by the nurse, would be most appropriate at this time?

Accepted Answer

The most appropriate action for the nurse to take at this time is to ask the patient about her concerns, feelings, and perceptions about the surgery. Providing teaching during periods of high anxiety is ineffective and does not address the patient's anxiety. Telling the patient that there is nothing to worry about is giving false reassurance. Calling the patient's family and demanding that they help out is projecting the nurse's frustration onto the family and avoiding responsibility.

Question 10

Which statement, if made by the nurse, is an example of a communication technique that can facilitate communication?

Accepted Answer

Using open-ended questions such as "What are you thinking about?" are more likely to facilitate communication. Making comments such as "Yes, I agree with you" and "You need to talk to your doctor" are not therapeutic communication techniques. Stating "I know just how you feel" is never therapeutic because no one can say how another person feels even if the nurse had a similar experience.

Question 11

The physician orders a dose of morphine that the nurse considers excessive. The nurse should

Accepted Answer

The physician must be notified for clarification of the dose. If the nurse still considers the dose excessive, he or she may refuse to administer it. Administering the medication is not a safe option, nor is asking another nurse to administer it. If the issue cannot be resolved between the nurse and physician, the supervisor should be notified.

Question 12

The nurse is caring for a patient 2 hours after a left above-the-knee amputation. The patient states, "My left leg is really hurting, and that medicine you gave me earlier didn't help." Which response is the most therapeutic, if made by the nurse?

Accepted Answer

"I will call your physician" is validating the patient's perception of pain. "That's impossible!" minimizes the patient's feelings. "You'll have to talk to your doctor" may cause the patient to feel rejected by the nurse. Making a stereotypical comment such as "Keep your chin up" is never therapeutic.

Question 13

The RN is educating the new RN on the primary focus of care when developing a therapeutic relationship with the patient. Which statement by the new RN indicates that teaching has been effective?

Accepted Answer

The primary focus of care is on the patient's needs and problems. The focus of the nurse-patient therapeutic relationship is never to meet the needs of the nurse. Medication administration and self-care potential can be addressed once needs and problems have been identified.

Question 14

The student nurse is listening to a lecture on therapeutic communication. Which statement indicates that teaching has been effective?

Accepted Answer

The purpose of therapeutic communication is to establish a trusting relationship. The RN should try to understand with sensitivity. Therapeutic communication and the establishment of the therapeutic relationship require empathy, genuineness, positive regard, and self-awareness. Psychotherapy, social communication, and emotional commitment to another are not definitions of therapeutic communication.

Question 15

The student nurse is listening to a lecture on communication. Which statement indicates that the teaching has been effective?

Accepted Answer

Communication blockers tend to stop conversation and build mistrust. Giving advice fosters dependency and conveys to the patient that the nurse knows best. Silence, eye contact, and clarifying are techniques that enhance (facilitate) communication.

Question 16

The RN has assigned the nursing assistant (NA) a task. The NA becomes angry and begins yelling at the RN. What is the best approach for the RN to take?

Accepted Answer

Meeting with the NA to explore the reason for resisting the request is the best approach in order to address the underlying issue. Telling the NA that you will let her leave early if she will do this for you and ignoring her and reassigning the task are negative reinforcements and will likely perpetuate the behavior. Calling the nursing supervisor and reporting the NA for insubordination should occur if the RN has been unsuccessful in resolving the problem.

Question 17

The RN is documenting the patient's complaint of pain rated 6 on a scale of 0 to 10. Which chart entry would be the most appropriate, if made by the nurse?

Accepted Answer

With "Pt complaining of pain rated at 6 on a scale of 0-10, states 'My left leg is really hurting.' Pt. grimacing, voice elevated. MD notified," the entry contains the problem, the assessment, subjective comments, observations, and the plan. The entry "Pt. complaining of pain. MD notified," does not define the patient's pain. The entries "Pt. complaining of pain rated at 6 on a scale of 0-10. Appears to be in pain. MD notified" and "Pt. complaining of pain rated 6. Wants more pain medication; appears to be drug-seeking. MD notified" reflect opinions of the nurse.

Question 18

A patient has just been informed by the physician that he will not be discharged today. The nurse brings in the patient's lunch tray and puts it on the overbed tray. The patient pushes it off onto the floor and shouts, "Get out of my room and leave me alone." The nurse's most therapeutic response would be

Accepted Answer

"You seem angry. Can you tell me about it?" is the most therapeutic response. The nurse must project warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family. Additionally, empathy is the ability to perceive the patient's needs, feelings, and situation accurately. Additionally, asking open-ended questions allows the patient to express thoughts and feelings freely with no response limitations. The other answer items are not examples of a therapeutic response to the angry patient.

Question 19

The nurse and patient are discussing the patient's perceptions and feelings related to the patient's illness. The patient is emotional and tearful and expresses feelings of hopelessness. During which phase of the nurse-patient relationship does the nurse interpret this patient to be in?

Accepted Answer

Discussing perceptions and feelings typically occurs in the working phase, at which time intense emotions may arise. Pre-orientation is not a phase of the nurse-patient relationship. The orientation phase includes introductions and goal setting. The termination phase is the completion of the nurse-patient relationship as a result of discharge, transfer, or the nurse's time off.

Question 20

The nurse is caring for a patient following painful radiation treatment for newly diagnosed cancer. Which question, if asked by the nurse in the orientation phase of the nurse-patient relationship, is most likely to elicit a meaningful response?

Accepted Answer

Pain must first be addressed before the interview can proceed. "Don't you love this weather?" is a general and nondescript comment. "How have things been going for you?" is best offered once pain has been assessed and treated. Exploration of needs, feelings, emotions, and concerns would be addressed in the working phase. "Tell me why you didn't stop smoking" is likely to elicit a defensive response and will hinder therapeutic communication.

Quiz 9: Communicating With Patients and Co-Workers