Question 1

A Filipino-American patient had this nursing diagnosis: Situational low self-esteem,related to poor social skills as evidenced by lack of eye contact.Interventions were used to raise the patient's self-esteem;however,after 3 weeks,the patient's eye contact did not improve.What is the most accurate analysis of this scenario?

Accepted Answer

The amount of eye contact in which a person engages is often culturally determined.In some cultures,eye contact is considered insolent,whereas in other cultures,eye contact is expected.Asian Americans,including persons from the Philippines,often prefer not to engage in direct eye contact.

Question 2

Which technique will best communicate to a patient that the nurse is interested in listening?

Accepted Answer

Restating allows the patient to validate the nurse's understanding of what has been communicated.Restating is an active listening technique.Judgments should be suspended in a nurse-patient relationship.Closed-ended questions such as,"Did you feel angry?" ask for specific information rather than show understanding.When the nurse simply states that he or she understands the patient's words,the patient has no way of measuring the understanding.

Question 3

A patient with acute depression states,"God is punishing me for my past sins." What is the nurse's best response?

Accepted Answer

The nurse reflects on the patient's comment,a therapeutic technique to encourage sharing for perceptions and feelings.The incorrect responses reflect probing,closed-ended comments,and giving advice,all of which are nontherapeutic.

Question 4

Documentation in a patient's chart shows,"Throughout a 5-minute interaction,patient fidgeted and tapped left foot,periodically covered face with hands,and looked under chair while stating,'I enjoy spending time with you.'" Which analysis is most accurate?

Accepted Answer

When a verbal message is not reinforced with nonverbal behavior,the message is confusing and incongruent.Some clinicians call it a "mixed message." It is inaccurate to say that the patient is giving positive feedback about the nurse's communication techniques.The concept of a cultural filter is not relevant to the situation;a cultural filter determines what a person will pay attention to and what he or she will ignore.Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

Question 5

A nurse interacts with a newly hospitalized patient.Select the nurse's comment that applies the communication technique of "offering self."

Accepted Answer

"Offering self" is a technique that should be used in the orientation phase of the nurse-patient relationship.Sitting with the patient,an example of "offering self," helps build trust and conveys that the nurse cares about the patient.Two incorrect responses are ineffective and nontherapeutic.The other incorrect response is therapeutic but an example of "offering hope."

Question 6

A patient says to the nurse,"I dreamed I was stoned.When I woke up,I felt emotionally drained,as though I hadn't rested well." Which comment would be appropriate if the nurse seeks clarification?

Accepted Answer

The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient's statement.Asking for a definition of "stoned" directly asks for clarification.Restating that the patient is uncomfortable with the dream's content is parroting,a nontherapeutic technique.The other responses fail to clarify the meaning of the patient's comment.

Question 7

During an interview,a patient attempts to shift the focus from self to the nurse by asking personal questions.The nurse should respond by saying:

Accepted Answer

When a patient tries to focus on the nurse,the nurse should refocus the discussion back onto the patient.Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way.Telling patients not to ask about the nurse's personal life shows indignation.Saying that nurses prefer to direct the interview reflects superiority.Saying "You've turned the tables on me" states the fact but does not refocus the interview.

Question 8

An African-American patient says to a Caucasian nurse,"There's no sense talking.You wouldn't understand because you live in a white world." The nurse's best action would be to:

Accepted Answer

Having the patient speak in specifics rather than globally helps the nurse understand the patient's perspective.This approach helps the nurse engage the patient.

Question 9

When a female Mexican-American patient and a female nurse sit together,the patient often holds the nurse's hand.The patient also links arm and arm with the nurse when they walk.The nurse is uncomfortable with this behavior and thinks the patient is homosexual.Which alternative is a more accurate assessment?

Accepted Answer

The most likely answer is that the patient's behavior is culturally influenced.Hispanic women frequently touch women they consider to be their friends.Although the other options are possible,they are less likely.

Question 10

A Puerto Rican-American patient uses dramatic body language when describing emotional discomfort.Which analysis most likely explains the patient's behavior? The patient:

Accepted Answer

Members of Hispanic-American subcultures tend to use high affect and dramatic body language as they communicate.The other options are more remote possibilities.

Question 11

The patient says,"My marriage is just great.My spouse and I usually agree on everything." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button.What conclusion can the nurse draw? The patient's communication is:

Accepted Answer

Mixed messages involve the transmission of conflicting or incongruent messages by the speaker.The patient's verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety.Data are not present to support the choice of the verbal message being clear,explicit,or inadequate.

Question 12

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

Accepted Answer

Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired,weigh alternatives,and formulate ideas.A nurse breaking silences is not a principle related to silences.Saying that patients withdraw during long silences or that silence helps patients know that they are understood are both inaccurate statements.Feedback helps patients know they have been understood.

Question 13

A Mexican-American patient puts a picture of the Virgin Mary on the bedside table.Under which section of the assessment should the nurse document this behavior?

Accepted Answer

Cultural heritage is expressed through language,works of art,music,dance,ethnic clothing,customs,traditions,diet,and expressions of spirituality.This patient's prominent placement of the picture is an example of expression of cultural heritage.

Question 14

The relationship between a nurse and patient as it relates to status and power is best described by which term?

Accepted Answer

When a difference in power exists,as between a student and teacher or between a nurse and patient,the relationship is said to be complementary.Symmetrical relationships exist between individuals of like or equal status.Incongruent and paralinguistic are not terms used to describe relationships.

Question 15

During the first interview with a parent whose child died in a car accident,the nurse feels empathic and reaches out to take the patient's hand.Select the correct analysis of the nurse's behavior.

Accepted Answer

Touch has various cultural and individual interpretations.Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch.The other options present prematurely drawn conclusions.

Question 16

A patient with paranoid schizophrenia tells the nurse,"The CIA is monitoring us through the fluorescent lights in this room.Be careful what you say." Which response by the nurse would be most therapeutic?

Accepted Answer

It is important not to challenge the patient's beliefs,even if they are unrealistic.Challenging undermines the patient's trust in the nurse.The nurse should try to understand the underlying feelings or thoughts the patient's message conveys.The correct response uses the therapeutic technique of reflection.The other comments are nontherapeutic.Asking to talk about something other than the concern at hand is changing the subject.Saying that the CIA is prohibited from operating in health care facilities gives false reassurance.Stating that the patient has lost touch with reality is truthful but uncompassionate.

Question 17

A patient tells the nurse,"I don't think I'll ever get out of here." Select the nurse's most therapeutic response.

Accepted Answer

By asking if the patient does not believe that progress has been made,the nurse is reflecting by putting into words what the patient is hinting.By making communication more explicit,issues are easier to identify and resolve.The remaining options are nontherapeutic techniques.Telling the patient not to "talk that way" is disapproving.Saying that everyone feels that way at times minimizes feelings.Telling the patient that good work will always result in success is falsely reassuring.

Question 18

While talking with a patient with severe depression,a nurse notices the patient is unable to maintain eye contact.The patient's chin lowers to the chest while the patient looks at the floor.Which aspect of communication has the nurse assessed?

Accepted Answer

Eye contact and body movements are considered nonverbal communication.Insufficient data are available to determine the level of the patient's social skills or whether a cultural barrier exists.

Question 19

A patient discloses several concerns and associated feelings.If the nurse wants to seek clarification,which comment would be appropriate?

Accepted Answer

Asking,"Am I correct in understanding that…?" permits clarification to ensure that both the nurse and patient share mutual understanding of the communication.Asking about common elements encourages comparison rather than clarification.The remaining responses are implied questions that suggest the nurse was not listening.

Question 20

A patient is having difficulty making a decision.The nurse has mixed feelings about whether to provide advice.Which principle usually applies? Giving advice:

Accepted Answer

Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions.Giving advice also robs patients of the opportunity to weigh alternatives and to develop problem-solving skills.Furthermore,it contributes to patient feelings of personal inadequacy.It also keeps the nurse in control and feeling powerful.

Quiz 8: Communication Skills: Medium for All Nursing Practice