Chapter 08: Communication and the Nurse-Patient Relationship Williams: deWit's Fundamental Concepts and Skills for Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse can best ensure that communication is understood by: a. speaking slowly and clearly in the patient’s native language. b. asking the family members whether the patient understands. c. obtaining feedback from the patient that indicates accurate comprehension. d. checking for signs of hearing loss or aphasia before communicating. ANS: C The best way to determine understanding is to ask the patient. Factors such as anxiety, hearing acuity, language, aphasia, or lack of familiarity with medical jargon or routines can all contribute to misunderstanding. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #1 TOP: Feedback KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 2. The nurse recognizes a verbal response when the patient:
a. b. c. d.
nods her head when asked whether she wants juice. writes the answer to a question asked by the nurse. begins sobbing uncontrollably when asked about her daughter. is moaning and restless and appears to be in pain.
ANS: B Verbal communication involves words, either written or spoken. Nodding, sobbing, and moaning are nonverbal communication. DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #1 TOP: Verbal Communication Feedback KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 3. The nurse recognizes the patient who demonstrates communication congruency when the patient:
a. b. c. d.
smiles and laughs while speaking of feeling lonely and depressed. wrings her hands and paces around the room while denying that she is upset. is tearful and slow in speech when talking about her husband’s death. states she is comfortable while she frowns and her teeth are clenched.
ANS: C Congruent communication is the agreement of verbal and nonverbal messages. DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: Theory #1 TOP: Congruence KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
4. A Hispanic patient approaches the Asian nurse and, standing very close, touches the nurse’s shoulder during their conversation. The nurse begins to step back to 18 to 24 inches, while smiling and nodding to the patient. This situation is most likely an example of:
a. b. c. d.
the nurse’s need to maintain a professional role rather than a social role. a patient’s attempt to keep the nurse’s attention. a nurse’s need to establish a more appropriate location for conversation. a difference in culturally learned personal space of the nurse and the patient.
ANS: D Personal space between people is a culturally learned behavior; Asians, North American natives, and Northern European people generally prefer more personal space than people of Hispanic, Southern European, or Middle Eastern cultures. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #2 TOP: Cultural Differences KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 5. A nurse says to a patient, “I am going to take your TPR, and then I’ll check to see whether you can have a PRN analgesic.” In considering factors that affect communication, the nurse has:
a. b. c. d.
used terminology to clearly inform the patient of what she is doing. given information that is unnecessary for the patient to know. used medical jargon, which might not be understood by the patient. taken into consideration the patient’s need to know what is happening.
ANS: C Medical jargon such as abbreviations or medical terminology is often misunderstood, even by well educated people. DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: Theory #3 TOP: Blocks to Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 6. A nurse using active listening techniques would:
a. use nonverbal cues such as leaning forward, focusing on the speaker’s face, and slightly nodding to indicate that the message has been heard. b. avoid the use of eye contact to allow the patient to express herself without feeling stared at or demeaned. c. anticipate what the speaker is trying to say and help the patient express herself when she has difficulty with finishing a sentence. d. ask probing questions to direct the conversation and obtain the information needed as efficiently as possible. ANS: A Eye contact is a culturally learned behavior and in some cases may not be appropriate. Probing questions or finishing the patient’s sentence is not part of active listening and is detrimental to an interview. DIF: Cognitive Level: Comprehension TOP: Active Listening
REF: p. 104 OBJ: Theory #3 KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 7. When the patient says, “I don’t want to go home,” the nurse’s best therapeutic verbal response would be:
a. b. c. d.
“I’m sure everything will be fine once you get home.” “You don’t want to go home?” “Doesn’t your family want you to come home?” “I felt like that when I had surgery last year.”
ANS: B The use of reflecting encourages the patient to expand on his or her feelings or thoughts. DIF: Cognitive Level: Application REF: p. 105|Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 8. To begin talking with a newly admitted patient about pain management, the nurse would most appropriately state:
a. b. c. d.
“You look pretty comfortable. Are you having any pain?” “Tell me about the pain you’ve been having.” “Is this pain the same as the pain you had yesterday?” “Don’t worry; this pain won’t last forever.”
ANS: B An open-ended question allows the patient to express his or her feelings or needs. DIF: Cognitive Level: Application REF: p. 105|Table 8-1 OBJ: Theory #3 TOP: Communication Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 9. When a patient begins crying during a conversation with the nurse about the patient’s upcoming surgery for possible malignancy, the nurse’s most therapeutic response would be: a. “Your surgeon is excellent, and I know he’ll do a great job.” b. “Oh, dear, your gown is way too big, let me get you another one.” c. “Don’t cry; think about something else and you’ll feel better.” d. “Here is a tissue. I’d like to sit here for a while if you want to talk.” ANS: D Offering self, or presence, and accepting a patient’s need to cry is supportive. DIF: Cognitive Level: Application REF: p. 105|Table 8-1 OBJ: Theory #3 TOP: Therapeutic Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 10. To enhance the establishment of rapport with a patient, the nurse should:
a. identify himself by name and title each time he introduces himself. b. share his own personal experiences so that the patient gets to know him as a friend.
c. act in a trustworthy and reliable manner; respect the individuality of the patient. d. share information with the patient about other patients and why they are hospitalized. ANS: C Trust and reliability, as well as conveying respect for the individual, all promote rapport. Identifying oneself is important but in itself does not promote rapport. Sharing personal experiences or divulging the confidential nature of other patients’ conditions is not appropriate in the nurse-patient relationship. DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: Clinical Practice #2 TOP: Rapport KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 11. The nurse explains that the therapeutic nurse-patient relationship differs from the social relationship because:
a. b. c. d.
a social relationship does not have goals or needs to be met. the nurse-patient relationship ends when the patient is discharged. the focus is mainly on the nurse in the nurse-patient relationship. a social relationship does not require trust or sharing of life experiences.
ANS: B The nurse-patient relationship is limited to the patient’s stay in the facility and is focused on the patient. A social relationship may have goals or needs and does require trust and sharing of life experiences. DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: Theory #4 TOP: Relationships KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 12. The nurse has selected an outcome for the patient to eat all of the food on the breakfast tray each day. Assessing that the patient has eaten all of the breakfast, the nurse would give positive feedback by saying:
a. b. c. d.
“Wow! That breakfast must have been pretty good.” “I like pancakes too. Everyone on the hall seemed to enjoy them.” “I hope you can keep all that breakfast down.” “Hurray! You finished your whole meal! What would you like for tomorrow?”
ANS: D Giving positive feedback increases the likelihood of the desired behavior to be repeated. Commenting on the tastiness of the food or the fact that others liked it is not responding directly to the patient’s having eaten the whole meal. DIF: Cognitive Level: Application REF: p. 102 OBJ: Theory #9 TOP: Positive Feedback KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
13. A 67-year-old woman had major abdominal surgery yesterday. She has IV lines, a urinary catheter, and an abdominal wound dressing, and she is receiving PRN pain medication. The end of shift report that best conveys the patient status is:
a. “Doing great, was up in the chair most of the day. No complaints of pain or discomfort. Voiding adequately.” b. “Abdominal surgery yesterday, dressing is dry and intact, her IVs are on time and she’s had pain meds twice. Vital signs stable.” c. “Abdominal dressing dry, IVs—800 mL left in #6; NS running at 125 mL/hr; urine output 800 mL this shift; had morphine 15 mg for pain at 8:00 AM and at 1:30 PM. She’s comfortable now. Vital signs are stable, no fever.” d. “Unchanged since this morning. She wanted to know how soon she can have something to eat, so maybe you could check with her doctor this evening. Her husband has been visiting all day and will let you know if she needs anything.” ANS: C This brief clear report addresses the major concerns of the abdominal dressing, the status of the IV fluids, vital signs, and analgesia needs. DIF: Cognitive Level: Application REF: p. 115|Box 8-2 OBJ: Clinical Practice #4 TOP: Shift Report KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 14. An aspect of computer use in patient care in which the LPN may need to be proficient includes:
a. input of data such as requests for radiographs or laboratory services. b. programming the computer to record data from primary care provider and other health care workers. c. educating patients how to use hospital computers to access information such as discharge instructions or information relative to specific medications. d. scheduling admissions, discharges, and nurse staffing to keep the unit at the best occupancy and utilization. ANS: A Facilities use computers for data entry relative to requesting radiograph, laboratory services, physical assessment and medication administration. Programming such computers is not a nursing task and patients need to have individualized information about discharge and medications. DIF: Cognitive Level: Knowledge TOP: Computer Use MSC: NCLEX: N/A
REF: p. 117 OBJ: Theory #8 KEY: Nursing Process Step: Implementation
15. A patient with a nursing diagnosis of Sensory perception, disturbed auditory, would most appropriately require the nurse to:
a. b. c. d.
obtain a sign language interpreter when a family member is unavailable. speak slowly and distinctly, but not shout. provide bright lighting without glare and orient frequently. reorient frequently to time, place, staff, and events.
ANS: B