Chapter 24: Communication Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank

MULTIPLE CHOICE

1. The client tells the nurse that he understands most of the information but still has questions concerning the medication after the nurse has provided the client with information regarding the treatment plan for the diagnosis the. This response is an example of:

1.

Referent

2.

Receiver

3.

Channel

4.

Feedback

ANS: 4

This response is an example of feedback. Feedback is the message returned by the receiver. The referent motivates one person to communicate with another, such as a time schedule. This is not an example of a referent. The receiver is the person who receives and decodes the message. This question is not asking about the receiver, but rather the response. Channels are means of conveying and receiving messages through visual, auditory, and tactile senses. This response is not an example of a channel.

DIF: A REF: 343 OBJ: Comprehension

TOP: Nursing Process: Implementation/Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

2. The nurse is in the process of conducting an admission interview with the client. At one point in the discussion, the client has provided information that the nurse would like to clarify. The nurse employs the technique of clarification as indicated by the response:

1.

Im not sure that I understand what you mean by that statement.

2.

The ECG records information about your hearts electrical activity.

3.

Lets look at the problem you have had with your medication when you were home.

4.

Whats your biggest concern related to your hospitalization at the moment?

ANS: 1

Im not sure that I understand what you mean by that statement is correct. Clarifying is when the nurse checks whether understanding is accurate by restating an unclear message to clarify the senders meaning, or by asking the other person to restate the message, explain further, or give an example of what the person means. This response indicates the nurse wants to clarify what the client is saying so he or she can have an accurate understanding of what the client means. The ECG records information about your hearts electrical activity is an example of providing information, not clarification. Lets look at the problem you have had with your medication when you were home is an example of focusing, not clarification. Whats your biggest concern related to your hospitalization at the moment is an example of sharing empathy.

DIF: A REF: 354 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

3. The faculty member is reviewing a process recording with the student nurse. The student has been working with a client who has had an amputation of the lower left leg and is emotionally fragile. The student receives positive feedback from the faculty member for the following response made to the client:

1.

Why are you so upset today?

2.

Im sure that everything will be all right.

3.

You shouldnt cry. The wound will heal soon.

4.

It must be very difficult to have this happen to you.

ANS: 4

It must be very difficult to have this happen to you is an example of using the therapeutic communication technique of sharing empathy. Why are you so upset today? is an example of a nontherapeutic communication technique of asking for explanations. Im sure that everything will be all right is an example of a nontherapeutic communication technique of giving false reassurance. You shouldnt cry. The wound will heal soon is an example of a nontherapeutic communication technique of giving disapproval.

DIF: A REF: 353 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

4. When reaching over the side rails to take a clients blood pressure, he draws back. To promote effective communication, the nurse should first:

1.

Tell the client that the blood pressure can be taken at a later time

2.

Rotate the nurses who are assigned to take the clients blood pressure

3.

Continue to perform the blood pressure assessment quickly and quietly

4.

Apologize for startling the client and explain the need for touching the client

ANS: 4

Nurses often have to enter a clients personal space to provide care. The nurse should convey confidence, gentleness, and respect for privacy. This response demonstrates respect and provides information so the client can understand the need for personal contact. Telling the client that the blood pressure can be taken at a later time does not promote effective communication. Rotating the nurses who are assigned to take the clients blood pressure impedes the nurses ability to form a therapeutic, helping relationship. Continuing to perform the procedure quickly and quietly may send a negative nonverbal message. It also does not promote effective communication.

DIF: A REF: 343 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

5. Communication involves both active listening and body language working together. The nurse actively listens to the client and:

1.

Sits facing the client

2.

Keeps the arms and legs crossed

3.

Leans back in the chair away from the client

4.

Avoids eye contact as much as is physically possible

ANS: 1

Active listening means to be attentive to what the client is saying both verbally and nonverbally. A nonverbal skill to facilitate attentive listening is to sit facing the client. This posture gives the message that the nurse is there to listen and is interested in what the client is saying. For active listening, the arms and legs should be uncrossed. This posture suggests that the nurse is open to what the client says. For active listening, the nurse should lean toward the client. This posture conveys that the nurse is involved and interested in the interaction. For active listening, the nurse should establish and maintain intermittent eye contact. This conveys the nurses involvement in and willingness to listen to what the client is saying.

DIF: A REF: 344 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

6. During the assessment phase of the nursing process, the nurse may uncover data that help to identify communication problems. An example of this information is:

1.

Extreme dyspnea or shortness of breath

2.

Urinary frequency and pain

3.

Chronic stomach pain

4.

Lack of appetite

ANS: 1

An extremely breathless person must use oxygen to breathe rather than speak. Urinary frequency may interrupt conversation but is not a communication problem. Chronic stomach pain would not be a communication problem. The patient with chronic pain is, to some degree, used to the pain. A lack of appetite is not a communication problem.

DIF: A REF: 349 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

7. When a nurse tells an advanced nurse practitioner that her client is slipping a little in reference to hemodynamic pressures, The nurse is using:

1.

Brevity

2.

Relevance

3.

Pacing and control.

4.

Connotative meaning

ANS: 4

The connotative meaning is the shade or interpretation of a words meaning influenced by the thoughts, feelings, or ideas people have about the word. Slipping a little in reference to hemodynamic pressures is an example of using connotative meaning. Brevity means that communication is simple, brief, and direct. This is not an example of using brevity. Relevance means the message is relevant or important to the situation at hand. This is not an example of using relevance. Pacing and control mean speaking slowly enough to enunciate clearly and not changing subjects rapidly. This is not an example of using pacing and control.

DIF: A REF: 344 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

8. A client is admitted for a CAT scan (diagnostic test) of the cranium. As the nurse explains this diagnostic test, the client moves away from the nurse. This is an example of what influencing factor in communication?

1.

Gender

2.

Environment

3.

Space and territoriality

4.

Sociocultural background

ANS: 3

Territoriality is the need to gain, maintain, and defend ones right to space. The client who moves away from the nurse during a conversation is demonstrating the influence of space and territoriality on communication. This not an example of gender influencing communication. This is not an example of environment influencing communication. Noise, temperature extremes, distractions, and lack of privacy are examples of environmental factors that may influence communication. Although people do maintain varying distances between each other depending on their culture, this is not an example of sociocultural background influencing communication, as cultural orientation is not mentioned in this situation.

DIF: A REF: 345 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

9. The nurse will often display empathy in communication with clients. Of the following responses by the nurse, which one best conveys empathy?

1.

Good morning. How did you sleep last night?

2.

I can understand your concern about learning to inject yourself.

3.

Do you mean you would like to talk to the new family nurse practitioner?

4.

Can you describe to me what the pain in your abdomen feels like right now?

ANS: 2

I can understand your concern about learning to inject yourself is correct. Empathy is the ability to understand and accept another persons reality, to accurately perceive feelings, and to communicate this understanding to others. Good morning. How did you sleep last night? is asking a question. It does not convey empathy. Do you mean you would like to talk to the new family nurse practitioner? is asking a question to clarify the clients meaning. It does not convey empathy. Can you describe to me what the pain in your abdomen feels like right now? is asking a relevant question that may focus on a particular topic. It is not an example of empathy.

DIF: A REF: 353 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

10. In working with a client who is newly diagnosed with diabetes mellitus, the nurse provides feedback to the client on her progress in learning the treatment regimen. Of the following, the nurse demonstrates the use of therapeutic communication by stating:

1.

I believe that you have come a long way in learning how to manage your care.

2.

It didnt look like you were ever going to be able to get the injection technique.

3.

Check your blood sugar unless you really want to come back to the hospital again.

4.

You dont appear to have any real interest in managing your daily dietary intake.

ANS: 1

In stating, I believe that you have come a long way in learning how to manage your care the nurse is demonstrating the use of therapeutic communication by sharing hope. The nurse is pointing out that personal growth can come from illness experiences. It didnt look like you were ever going to be able to get the injection technique is a negative statement. The nurse should not state observations that might embarrass or anger the client. Check your blood sugar unless you really want to come back to the hospital again does not demonstrate the use of therapeutic communication. It implies disapproval and is an aggressive, threatening type of response. You dont appear to have any real interest in managing your daily dietary intake is not a therapeutic statement. It is negative and aggressive in nature. If it is a true observation, it is one the nurse should not state as it could anger the client.

DIF: A REF: 353 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

11. Ive never told anyone this information about my son, is an example of a parent:

1.

Identifying problems

2.

Building trust

3.

Clarifying roles

4.

Revealing

ANS: 2

This response is an example of trust. Trusting another person involves risk and vulnerability, but it also fosters open, therapeutic communication and enhances the expression of feelings, thoughts, and needs. This statement is not an example of revealing. Although the parent may have provided information that was never before revealed, in this statement the parent is indicating there is trust between himself or herself and the nurse practitioner. This statement is not clarifying roles of the nurse and client. This statement is not an example of identifying problems and goals.

DIF: A REF: 348 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

12. Discussing the clients follow-up dietary needs immediately after the surgery when the client is experiencing discomfort is an error in:

1.

Pacing

2.

Intonation

3.

Timing and relevance

4.

Denotative meaning

ANS: 3

Discussing follow-up dietary needs immediately after surgery when the client is experiencing discomfort is an error in timing and relevance. The client is less likely to be able to pay attention and comprehend instruction when in pain, and immediately after surgery, discussing follow-up dietary needs would seem irrelevant. Pacing has to do with the speed of conversation. This is not an example of an error in pacing. Intonation is the tone of voice used. This is not an example of an error in intonation. Denotative meaning is when a single word can have several meanings. This is not an example of an error in denotative meaning.

DIF: A REF: 3744 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

13. The nurse is aware of the clients zones of personal space when planning interactions. The zone of personal space and touch that extends the greatest amount from an individual is the:

1.

Social zone

2.

Personal zone

3.

Consent zone

4.

Vulnerable zone

ANS: 1

The social zone extends the greatest amount from an individual in personal space and touch. It is a distance of 4 to 12 feet. Permission is not needed for touch in the social zone. The personal zone is 18 inches to 4 feet. The consent zone of touch requires permission. The vulnerable zone is in the consent zone of touch. Because the vulnerable zone implies special care is needed, permission is required.

DIF: A REF: 348 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

14. Throughout the nursing process communication is used. During the evaluation phase, communication is specifically used by the nurse to:

1.

Delegate activities to other staff members

2.

Validate the clients health and wellness needs

3.

Acquire both verbal and nonverbal client feedback

4.

Document expected outcomes and planned interventions

ANS: 3

The nurse and client determine whether the plan of care has been successful by evaluating the client communication outcomes established during planning. This process involves acquiring verbal and nonverbal feedback. Delegation is not the purpose of communication in the evaluation phase of the nursing process. Delegation is more likely to be used in the implementation phase of the nursing process. Validation of the clients needs is not why the nurse specifically uses communication in the evaluation phase of the nursing process. Validation of the clients needs is often determined when data are gathered during the assessment phase of the nursing process. Documenting expected outcomes and planned interventions is part of the planning phase of the nursing process, not the evaluation phase.

DIF: A REF: 344 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

15. There are a number of variables that may influence the clients communication with the health care team. Which of the following is an example of an interpersonal variable?

1.

Postoperative discomfort

2.

An extremely warm room

3.

A talkative roommate

4.

A loud television

ANS: 1

Interpersonal variables are factors within both the sender and receiver that influence communication. An example of an interpersonal variable is postoperative discomfort. An extremely warm room is an example of an environmental variable that may affect communication. A talkative roommate is an example of an environmental variable that may affect communication because of the lack of privacy and distraction. Noise, such as a loud television, is an example of an environmental variable that may affect communication.

DIF: A REF: 343-344 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

16. A helping relationship is being established between nurse and client. In addressing the client, the nurse should:

1.

Use the clients first name

2.

Touch the client right away to establish contact

3.

Sit far enough away from the clients personal space

4.

Always knock and pause before entering the clients room

ANS: 4

Common courtesy is part of professional communication. To practice courtesy, the nurse says hello and goodbye, knocks on doors before entering, and uses self-introduction. Knocking on doors is important in addressing the client. Because using last names is respectful in most cultures, nurses usually use the clients last name in the initial interaction, and then use the first name if the client requests it. Touching the client right away would not be an appropriate action in establishing a helping relationship. It would more likely be interpreted as invading the clients personal space. Sitting far enough away from the client is important in that the nurse should not enter the clients personal space when establishing a helping relationship. However, leaning toward the client conveys that the nurse is involved and interested in the client. Knocking on the door before entering the clients room would be the first step in addressing the client properly.

DIF: A REF: 348 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

17. In using communication skills with clients, the nurse evaluates which response as being the most therapeutic?

1.

Why dont you stick to the special diet?

2.

I noticed that you didnt eat lunch. Is something wrong?

3.

I think you need to find another physician thats better than this one.

4.

We cant continue talking about your problems; its time for your bath.

ANS: 2

The nurse who is sharing an observation, I noticed that you didnt eat lunch. Is something wrong? is using the most therapeutic response. Sharing observations often helps the client communicate without the need for extensive questioning, focusing, or clarification. Why dont you stick to the special diet? is an example of a nontherapeutic response. It is asking for an explanation. Why questions can cause resentment, insecurity, and mistrust. I think you need to find another physician thats better than this one. is not a therapeutic response. It is giving a personal opinion. Changing the subject, We cant continue talking about your problems; its time for your bath, is not therapeutic.

DIF: A REF: 352 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

18. When dealing with toddlers or preschoolers what communication technique may be used most effectively?

1.

Using analogies to explain health-related ideas

2.

Allowing manipulation of equipment to be used

3.

Moving quickly and minimizing contact to avoid distress

4.

Focusing on what other children on the unit may have been doing

ANS: 2

Allowing toddlers and preschoolers to touch and examine objects that will come in contact with them is an effective communication technique. Toddlers and preschoolers are unable to understand analogies. Sudden movements can be frightening. Children often prefer to make the first move in interpersonal contacts. Focusing on what other children have done is not an effective communication technique for toddlers or preschoolers. Communication should be focused on the child.

DIF: A REF: 350 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

19. When working with a client with aphasia, the nurse may attempt to enhance communication by:

1.

Using visual cues

2.

Speaking loudly

3.

Using open-ended questions

4.

Communicating through a speech therapist

ANS: 1

The nurse may enhance communication for a client with aphasia by using visual cues (e.g., words, pictures, and objects) when possible. The nurse should not shout or speak too loudly to enhance communication with a person who has aphasia. The nurse should ask simple questions that require yes or no answers to enhance communication with the client who has aphasia. Using a speech therapist is not the primary way to enhance communication with a client who has aphasia. The nurse can use communication techniques to facilitate communication and to develop a helping relationship with the client. The speech therapist may help the client to learn new ways or to relearn how to communicate.

DIF: A REF: 357 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

20. Which of the following statements best reflects the clients positive feedback to the nurses question, Do you understand how to check your blood sugar?

1.

Nodding affirmatively

2.

I test it 4 times a day.

3.

Yes, I understand how to do it.

4.

Demonstrating a fingerstick to the nurse

ANS: 4

Feedback is the message the receiver returns. It indicates whether the receiver understood the meaning of the senders message. Demonstrating the technique is the best way to show the nurse an understanding of the process. The other options either nonverbally or verbally indicate understanding; they are not as conclusive as showing understanding.

DIF: C REF: 343 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

21. Which of the following nursing statements is the best example of the communication tool of clarification?

1.

Please say that again.

2.

I dont think I understand.

3.

What did you mean by that?

4.

Can you give me an example?

ANS: 4

To check whether understanding is accurate, ask the other person to rephrase it, explain further, or give an example of what the person means. By asking for an example, the nurse is best able to determine the meaning of the clients statement. The other options either simply ask the client to repeat the statement or state that the nurse needs further information.

DIF: C REF: 354 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

22. Which of the following is the single most negative factor affecting a nurses credibility?

1.

Deficient technical skills

2.

Unethical or illegal behavior

3.

Lack of caring and empathy

4.

Poor nurse-client communication

ANS: 4

Breakdown in communication is a top contributor to errors in the workplace and threatens professional credibility. The remaining options affect credibility but not to the extent that poor communication does.

DIF: C REF: 340 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

23. The best communicator is the nurse who:

1.

Thinks critically

2.

Is a good listener

3.

Is comfortable talking

4.

Empathizes with the client

ANS: 1

Nurses who develop good critical thinking skills make the best communicators. The remaining options identify components of good communication.

DIF: C REF: 340-341 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

24. Which of the following statements shows the best attempt by a nurse to overcome personal biases?

1.

So how does that make you feel?

2.

Most people really like Dr. Jones.

3.

I know how that must frighten you.

4.

How much did the medication help your pain?

ANS: 1

People often assume that others think, feel, act, react, and behave as they would in similar circumstances. They tend to distort or ignore information that goes against their expectations, preconceptions, or stereotypes. This statement clearly shows the nurse attempting to assist the client in expressing his or her personal feelings. The remaining options all make a presumption about the clients feelings or attitudes.

DIF: C REF: 341 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

25. A close, effective nurse-client relationship impacts interpersonal communication most by facilitating:

1.

Client education regarding health-related issues

2.

The accurate interpretation of shared information

3.

A free exchange of information between client and nurse

4.

The clients expression of physical and emotional needs

ANS: 2

The more the sender and receiver have in common and the closer the relationship, the more likely they will accurately perceive one anothers meaning and respond accordingly. The remaining options are outcomes of an effective nurse-client relationship but they do not impact communication as directly.

DIF: C REF: 340 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

26. Mentally reviewing the steps of a complicated nursing procedure before entering the clients room is an example of:

1.

Nonverbal communication

2.

Interpersonal communication

3.

Intrapersonal communication

4.

Transpersonal communication

ANS: 2

A type of intrapersonal communication, self-instructions, provides a mental rehearsal for difficult tasks or situations so individuals are able to deal with them more effectively. Interpersonal communication is one-to-one interaction between the nurse and another person that often occurs face to face while transpersonal communication is interaction that occurs within a persons spiritual domain. Nonverbal communication includes all five senses and everything that does not involve the spoken or written word.

DIF: A REF: 342 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

27. The nurse can best detect that a client needs clarification of the information provided on a special diet by:

1.

Asking the client frequently if they have any questions

2.

Assessing the clients nonverbal cues that suggest confusion

3.

Providing the client with written supportive materials on the diet

4.

Requesting that the client rephrase the information in his or her own words

ANS: 2

You determine the need for clarification by watching the listener for nonverbal cues that suggest confusion or misunderstanding. The remaining options are means of reinforcing or evaluating the listeners understanding of the information.

DIF: C REF: 354 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

28. The nurse observes a client with head bowed and hands folded seemingly in prayer. The nurse recognizes this as an example of:

1.

Nonverbal communication

2.

Interpersonal communication

3.

Intrapersonal communication

4.

Transpersonal communication

ANS: 4

Transpersonal communication is interaction that occurs within a persons spiritual domain. Many persons use prayer, meditation, guided reflection, religious rituals, or other means to communicate with their higher power. Intrapersonal communication, self-talk or self-instruction provides a mental rehearsal for difficult tasks or situations so individuals are able to deal with them more effectively. Interpersonal communication is one-to-one interaction between the nurse and another person that often occurs face to face while nonverbal communication includes all five senses and everything that does not involve the spoken or written word.

DIF: A REF: 342 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

29. The nurse is discussing discharge instructions with a client who was recently diagnosed with type 1 diabetes mellitus and is now taking insulin. The nurse recognizes this as an example of:

1.

Nonverbal communication

2.

Interpersonal communication

3.

Intrapersonal communication

4.

Transpersonal communication

ANS: 2

Interpersonal communication is one-to-one interaction between the nurse and another person that often occurs face to face. Transpersonal communication is interaction that occurs within a persons spiritual domain whileintrapersonal communication, self-talk or self-instruction provides a mental rehearsal for difficult tasks or situations so individuals are able to deal with them more effectively. Nonverbal communication includes all five senses and everything that does not involve the spoken or written word.

DIF: A REF: 342 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

30. A nurse provides a brief but concise orientation to the use of the rooms telephone and television to a newly admitted older client experiencing abdominal pain. The clients daughter later reports that her father attempted to call her but was never shown how to use the telephone. The most likely cause for the clients apparent lack of knowledge retention is:

1.

Admission to the hospital has caused mild confusion that is not atypical in older clients

2.

The pain was distracting him from focusing on the information when it was provided

3.

He is experiencing forgetfulness regarding newly introduced nonessential information

4.

The nurse did not take adequate time to explain the use of either the telephone or the television

ANS: 2

Timing is critical in communication. Even though a message is clear, poor timing prevents it from being effective. Do not begin routine teaching when a client is in severe pain or emotional distress. Although the other options may affect client retention of information, the scenario did not provide reason to believe that any of the options rather than poor timing was the primary factor.

DIF: C REF: 344 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

31. An older client who appears confused after discussing his new diagnosis of Parkinsons disease shares with the nurse that, I didnt understand much of what you said. The nurse determines that the most likely cause of the clients failure to understand is that:

1.

The conversation included unfamiliar medical terminology

2.

The client is in denial concerning the diagnosis of Parkinsons disease

3.

The nurses choice of timing for the client education was poor

4.

The etiology of the condition is too complicated for this client to understand

ANS: 1

Medical jargon (technical terminology used by health care providers) sounds like a foreign language to clients unfamiliar with the health care setting. Limiting use of medical jargon to conversations with other health team members will improve communication. The remaining options may have contributed to the problem, but the more common problem deals with inappropriate use of jargon.

DIF: C REF: 344 OBJ: Analysis

TOP: Nursing Process: Planning/Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

32. The nurse shares with a client diagnosed with bipolar disorder who is in the manic phase that, The CNA will be in 20 minutes to complete your ADLs. This nurse-initiated communication will likely result in client confusion or noncompliance because:

1.

The timing of the conversation was poorly chosen

2.

The client was not actively involved in the decision-making process

3.

The conversation relied on terms familiar only to health care providers

4.

The nurse assumed that the client would accept the nursing assistants help

ANS: 3

Medical jargon (technical terminology used by health care providers) sounds like a foreign language to clients unfamiliar with the health care setting. Limiting use of medical jargon to conversations with other health team members will improve communication. The remaining options may contribute to client confusion and/or noncompliance, but the heavy reliance on unfamiliar terms is the most likely primary cause in this situation.

DIF: C REF: 344 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

33. The nurse sits on a chair alongside a clients bed to discuss the postoperative nursing care the client will receive. The therapeutic outcome of sitting beside the client is that:

1.

The nurse-client relationship will be strengthened

2.

The client will feel less threatened by the nurses presence

3.

The nurse can appear more relaxed during the conversation

4.

The nurse and client will be equal participants in the conversation

ANS: 1

Looking down on a person establishes authority, whereas interacting at the same eye level indicates equality in the relationship. While the remaining options may be correct in some situations, the primary benefit of the nurse sitting is to convey to the client that both are equal contributors to the conversation.

DIF: C REF: 345 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

34. The nurse enters a clients room and finds her crying softly. The most therapeutic statement the nurse can make at this time is to ask:

1.

Are you alright?

2.

Why are you crying?

3.

What can I do to help you?

4.

Is being hospitalized upsetting you?

ANS: 2

Sounds have several interpretations: crying may communicate happiness, sadness, or anger. The nurse needs to validate such nonverbal messages with the client to interpret them accurately. Although the other options may elicit information regarding the clients tears, they make assumptions or attempt to provide generalized comfort without first establishing the cause of the tears.

DIF: C REF: 345 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

35. Supporting a client by holding onto her elbow while accompanying her as she ambulates around the nursing unit is considered social touching and so would typically:

1.

Be considered nonthreatening by the client

2.

Not require the clients permission

3.

Be viewed as therapeutic by the nurse

4.

Not be needed unless the client was ataxic

ANS: 2

A persons hands, arms, shoulders, and back are considered social zones and typically do not cause a client emotional discomfort if touched, and so permission to do so is not generally required. Nurses frequently move into clients personal space because of the nature of caregiving. You need to convey confidence, gentleness, and respect for privacy, especially when your actions require intimate contact or involve a clients vulnerable zone. The remaining options do not necessarily deal with a clients social touching zone.

DIF: C REF: 353-354 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

36. When meeting for the first time, the home health nurse smiles warmly and shakes the clients hand. The nurse-client relationship is in the:

1.

Working phase

2.

Orientation phase

3.

Termination phase

4.

Preinteraction phase

ANS: 2

When the nurse and client meet and get to know one another, they are engaged in the orientation phase of the nurse-client relationship. The remaining options are phases that occur either before or after the orientation phase.

DIF: C REF: 346 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

37. The nurse recognizes that a clients sense of personal control is most therapeutically impacted when:

1.

The client attends a self-help/support group

2.

The nurse encourages the client to make menu selections

3.

The client views a video on the use of a personal glucose monitor

4.

The nurse provides instructions on a patient-controlled analgesic (PCA) pump

ANS: 4

Personal control over the situation contributes to emotional comfort. Pain control is a very basic need, and by providing the client with the power to control that pain, the need has been therapeutic. The remaining options contribute to personal control but not on the same elemental level as pain control.

DIF: C REF: 348 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

38. Which of the following statements made by a nurse best reflects an understanding of the therapeutic value of perceived client control?

1.

The client was very interested in the information about support groups.

2.

The client fell right to sleep when I told her the procedure was canceled.

3.

Research has shown that clients are less stressed when told what to expect.

4.

I always include the client in on any decisions regarding their nursing care.

ANS: 3

Research has shown that personal control over a situation contributes to emotional comfort. By informing the client of expectations, the clients personal sense of control is increased and emotional stress should then be decreased. The remaining options show an understanding of emotional comfort but do not express an understanding of the origin of that comfort.

DIF: C REF: 348 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

39. Which of the following statements made by a nurse most reflects a poor understanding of trustworthiness regarding nurse-client communication in response to a clients report that, I dont like the night shift nurse?

1.

How can I meet your needs and expectations on dayshift?

2.

Tell me more about why you dislike the night shift nurse.

3.

Can you give me an example of why you are dissatisfied?

4.

The nurse on night shift has your well being in mind always.

ANS: 2

To foster trust, the nurse communicates warmth and demonstrates consistency, reliability, honesty, competence, and respect. Sharing personal information or gossiping about others sends the message you cannot be trusted and damages interpersonal relationships. The nurse appears to be gossiping by the way the client is encouraged to discuss what the night shift nurse is doing. The remaining options show varying degrees of addressing the clients statement.

DIF: C REF: 348 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

40. Which of the following statements made by a nurse most reflects the best understanding of the effect assertiveness has on interpersonal communication?

1.

Can anyone help; Im feeling overwhelmed today?

2.

I think we need to tell the doctors to write more legibly.

3.

I will need some help with that complicated dressing change.

4.

You will need to do the admission assessments today because Im so busy.

ANS: 3

Assertiveness conveys a sense of self-assurance while also communicating respect for the other person. Assertive responses often contain I messages, such as I want, I need, I think, or I feel, but in a fashion that is not demeaning or demanding. The remaining options are not the best examples because some lack an explanation of the nurses actual needs while others are not respectfully stated.

DIF: C REF: 348 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

41. The nurse identifies the nursing diagnosis risk for injury for a client who is unable to verbally communicate effectively. The primary risk for injury occurs because the client:

1.

Lacks the ability to tell the staff what he or she needs

2.

Cannot notify the staff when he or she has fallen

3.

Is not able to effectively use the call bell to communicate

4.

Displays impatience when needs are not met effectively

ANS: 1

The client who cannot communicate effectively will often have difficulty expressing needs and responding appropriately to the environment. A client who is unable to speak is at risk for injury unless the nurse identifies an alternate communication method. The remaining options relate to potential outcomes of ineffective verbal communication but not to the risk for injury.

DIF: C REF: 351 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

42. Which of the following statements made by a nurse reflects a need for further instruction regarding communicating with the older adult client?

1.

Children and the elderly have the same communication barriers.

2.

If I tell him why he needs to know something, hell usually listen.

3.

Hearing deficits can certainly make communication a challenge.

4.

I always try to have family around when I talk with an elderly client.

ANS: 1

Even though some older adults have communication barriers, you need to communicate with them on an adult level and avoid patronizing or speaking in a condescending manner. Older adults do not necessarily have the same barriers as children. The remaining options reflect interventions and/or statements that are not inappropriate and so do not require further instructions.

DIF: C REF: 356-357 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. Which of the following critical thinking attitudes contributes to an effective nurse-client relationship? (Select all that apply.)

1.

Fairness

2.

Guarded

3.

Curiosity

4.

Creativity

5.

Perseverance

6.

Self-confidence

ANS: 1, 3, 4, 5, 6

Curiosity motivates the nurse to communicate and know more about a person. Perseverance and creativity are also attitudes conducive to communication because they motivate the nurse to communicate and identify innovative solutions. A self-confident attitude is important because the nurse who conveys confidence and comfort while communicating more readily establishes an interpersonal, helping-trust relationship. Risk-taking rather than a guarded attitude is important because colleagues sometimes question the suggested nursing interventions. At the same time, an attitude of fairness goes a long way in the ability to listen to both sides of any discussion.

DIF: C REF: 340-341 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

2. The nurse realizes that the cancer support group for breast cancer clients will be most effective if the group: (Select all that apply.)

1.

Is not too large

2.

Is similar in age

3.

Members feel valued

4.

Communicates freely

5.

Shares a common culture

6.

Meets in a comfortable place

ANS: 1, 3, 4, 6

Small groups are more effective when they are a workable size and have an appropriate meeting place, suitable seating arrangements, and cohesiveness and commitment among group members. Group participants need to feel accepted, feel able to communicate openly and honestly, and actively listen to others in the group. Similarity in age and similarity in culture are not necessary criteria for a successful group interaction.

DIF: C REF: 342 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

3. The nurse is preparing a community outreach program on stress management. The nurse realizes that speaking in public requires some specific adaptations regarding: (Select all that apply.)

1.

Makeup

2.

Clothing attire

3.

Vocal inflection

4.

Voice projection

5.

Physical gesturing

6.

Making eye contact

ANS: 3, 4, 5, 6

Public communication requires special adaptations in eye contact, gestures, voice inflection, and use of media materials to communicate messages effectively. Makeup and clothing need to be appropriate but do not require specific adaptations.

DIF: C REF: 342 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

4. Which of the following are reasons for communication during the assessment phase of the nursing process? (Select all that apply.)

1.

Providing information to the client

2.

Obtaining information from the client

3.

Establishment of the nurse-client relationship

4.

Identification of the clients physical health needs

5.

Mutual goal setting regarding client health needs

6.

Identification of clients emotional health

ANS: 1, 2, 4, 5, 6

The reasons for communication include information exchange, goal achievement, problem resolution, and expression of feelings. The initiation of the nurse-client relationship is not considered a facet of assessment communication.

DIF: C REF: 349 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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