TEST BANK FOR INTERPERSONAL RELATIONSHIPS
(PROFESSIONAL COMMUNICATION SKILLS FOR
NURSES) 7TH EDITION BY ELIZABETH C. ARNOLD;
KATHLEEN UNDERMAN BOGGS
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TEST BANK FOR INTERPERSONAL RELATIONSHIPS (PROFESSIONAL COMMUNICATION SKILLS FOR NURSES) 7TH
EDITION BY ELIZABETH C. ARNOLD; KATHLEEN UNDERMAN BOGGS
Effective communication with clients, families, and professional colleagues starts here! With Interpersonal
Relationships: Professional Communication Skills for Nurses, 7th Edition, you’ll see how good
communication skills can lead to achieving treatment goals in health care. Clear guidelines show how you
can enhance the nurse-client relationship through proven communication strategies as well as principles
drawn from nursing, psychology, and related theoretical frameworks. And you’ll see how to apply theory
to real-life practice with case studies, interactive exercises, and evidence-based practice studies. A two-time
winner of the AJN Book of the Year award, this book is updated to emphasize interdisciplinary
communication and QSEN competencies. From expert nursing educators Elizabeth Arnold and Kathleen
Underman Boggs, this comprehensive, market-leading text is unmatched for helping nurses develop
effective communication skills!
Table of contents
PART I: Conceptual Foundations of Interpersonal Relationships and Professional Communication
Skills
1. Theory-Based Perspectives and Contemporary Dynamics
2. Professional Guides for Nursing Communication
3. Clinical Judgment and Ethical Decision Making
4. Clarity and Safety in Communication
PART II: Essential Communication Skills
5. Developing Therapeutic Communication Skills
6. Variation in Communication Styles
7. Intercultural Communication
8. Therapeutic Communication in Groups
PART III: Therapeutic Interpersonal Relationship Skills
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9. Self-Concept in Professional Interpersonal Relationships
10. Developing Therapeutic Relationships
11. Bridges and Barriers in Therapeutic Relationships
12. Communicating with Families
13. Resolving Conflicts Between Nurse and Client
PART IV: Communicating to Foster Health Literacy and Health Promotion and Prevention of
Disease Among Diverse Populations
14. Communicating to Encourage Health Literacy and Health Promotion and Prevention of Disease
15. Health Teaching and Coaching
16. Empowerment-Oriented Communication Strategies to Reduce Stress
PART V: Accommodating Clients with Special Communication Needs
17. Communicating with Clients Experiencing Communication Deficits
18. Communicating with Children
19. Communicating with Older Adults
20. Communicating with Clients in Crisis
21. Communicating with Clients and Families at End of Life
PART VI: Collaborative and Professional Communication
22. Role Relationships and Interpersonal Communication
23. Communicating with Other Health Professionals
24. Communicating for Continuity of Care
25. Documentation in an Electronic Era
26. Communication at the Point of Care: Application of e-Health Technologies
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Chapter 1: Theory Based Perspectives and Contemporary Dynamics
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. When describing nursing to a group of nursing students, the nursing instructor lists all of the
following characteristics of nursing except
a. historically nursing is as old as mankind.
b. nursing was originally practiced informally by religious orders dedicated to care of
the sick.
c. nursing was later practiced in the home by female caregivers with no formal
education.
d. nursing has always been identifiable as a distinct occupation.
ANS: A
Historically, nursing is as old as mankind. Originally practiced informally by religious orders
dedicated to care of the sick and later in the home by female caregivers with no formal
education, nursing was not identifiable as a distinct occupation until the 1854 Crimean war.
There, Florence Nightingale’s Notes on Nursing introduced the world to the functional roles of
professional nursing and the need for formal education.
DIF: Cognitive Level: Comprehension
REF: p. 1
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. The nursing profession’s first nurse researcher, who served as an early advocate for high-quality
care and used statistical data to document the need for handwashing in preventing infection, was
a. Abraham Maslow.
b. Martha Rogers.
c. Hildegard Peplau.
d. Florence Nightingale.
ANS: D
An early advocate for high-quality care, Florence Nightingale’s use of statistical data to
document the need for handwashing in preventing infection marks her as the profession’s first
nurse researcher.
DIF: Cognitive Level: Knowledge
REF: p. 1
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. Today, professional nursing education begins at the
a. undergraduate level.
b. graduate level.
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c. advanced practice level.
d. administrative level.
ANS: A
Today, professional nursing education begins at the undergraduate level, with a growing number
of nurses choosing graduate studies to support differentiated practice roles and/or research
opportunities. Nurses are prepared to function as advanced practice nurse practitioners,
administrators, and educators.
DIF: Cognitive Level: Comprehension
REF: p. 2
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
4. Nursing’s metaparadigm, or worldview, distinguishes the nursing profession from other
disciplines and emphasizes its unique functional characteristics. The four key concepts that form
the foundation for all nursing theories are
a. caring, compassion, health promotion, and education.
b. respect, integrity, honesty, and advocacy.
c. person, environment, health, and nursing.
d. nursing, teaching, caring, and health promotion.
ANS: C
Individual nursing theories represent different interpretations of the phenomenon of nursing, but
central constructs—person, environment, health, and nursing—are found in all theories and
models. They are referred to as nursing’s metaparadigm.
DIF: Cognitive Level: Knowledge
REF: p. 2
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
5. When admitting a client to the medical-surgical unit, the nurse asks the client about cultural
issues. The nurse is demonstrating use of the concept of
a. person.
b. environment.
c. health.
d. nursing.
ANS: B
The concept of environment includes all cultural, developmental, and social determinants that
influence a client’s health perceptions and behavior. A person is defined as the recipient of
nursing care, having unique bio-psycho-social and spiritual dimensions. The word health derives
from the word whole. Health is a multidimensional concept, having physical, psychological,
sociocultural, developmental, and spiritual characteristics. The World Health Organization
(WHO, 1946) defines health as “a state of complete physical, mental, social well-being, not
merely the absence of disease or infirmity.” Nursing includes the promotion of health, prevention
of illness, and the care of ill, disabled, and dying people.
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DIF: Cognitive Level: Application
REF: p. 3
TOP: Step of the Nursing Process: Assessment
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MSC: Client Needs: Psychosocial Integrity
6. A young mother tells the nurse, “I’m worried because my son needs a blood transfusion. I don’t
know what to do, because blood transfusions cause AIDS.” Which central nursing construct is
represented in this situation?
a. Environment
b. Caring
c. Health
d. Person
ANS: D
The concept of environment includes all cultural, developmental, and social determinants that
influence a client’s health perceptions and behavior. Caring is not one of the four central nursing
constructs. The word health derives from the word whole. Health is a multidimensional concept,
having physical, psychological, sociocultural, developmental, and spiritual characteristics. The
World Health Organization (WHO, 1946) defines health as “a state of complete physical, mental,
social well-being, not merely the absence of disease or infirmity.” Nursing includes the
promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Person
is defined as the recipient of nursing care, having unique bio-psycho-social and spiritual
dimensions.
DIF: Cognitive Level: Application
REF: p. 2
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
7. The nurse performs a dressing change using sterile technique. This is an example of which
pattern of knowledge?
a. Empirical
b. Personal
c. Aesthetic
d. Ethical
ANS: A
Empirical knowledge is the scientific rationale for skilled nursing interventions. Personal ways
of knowing allow the nurse to understand and treat each individual as a unique person. Aesthetic
ways of knowing allow the nurse to connect in different and more meaningful ways. Ethical
ways of knowing refer to the moral aspects of nursing.
DIF: Cognitive Level: Comprehension
REF: p. 5
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Management of Care
8. The nurse-client relationship as described by Hildegard Peplau
a. would not be useful in a short-stay unit.
b. allows personal and social growth to occur only for the client.
c. facilitates the identification and accomplishment of therapeutic goals.
d. focuses on maintaining a personal relationship between the nurse and client.
ANS: C
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Hildegard Peplau offers the best-known nursing model for the study of interpersonal
relationships in health care. Her model describes how the nurse-client relationship can facilitate
the identification and accomplishment of therapeutic goals to enhance client and family wellbeing. In contemporary practice, Peplau’s framework is more applicable today in longer term
relationships, and in settings such as rehabilitation centers, long-term care, and nursing homes.
Despite the brevity of the alliances in acute care settings, basic principles of being a participant
observer in the relationship, building rapport, developing a working partnership, and terminating
a relationship remain relevant.
DIF: Cognitive Level: Knowledge
REF: p. 10
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
9. The identification phase of the nurse-client relationship
a. sets the stage for the rest of the relationship.
b. correlates with the assessment phase of the nursing process.
c. focuses on therapeutic goals to enhance client and family well-being.
d. uses community resources to help resolve health care issues.
ANS: C
Hildegard Peplau offers the best-known nursing model for the study of interpersonal
relationships in health care. Her model describes how the nurse-client relationship can facilitate
the identification and accomplishment of therapeutic goals to enhance client and family wellbeing.
DIF: Cognitive Level: Knowledge
REF: p. 10
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Management of Care
10. Abraham Maslow's needs theory is a framework that
a. begins with meeting basic psychosocial needs first.
b. ensures essential needs are satisfied, then people move into higher physiological
areas of development.
c. proposes that people are motivated to meet their needs in a descending order.
d. nurses use to prioritize client needs and develop relevant nursing approaches.
ANS: D
Abraham Maslow's needs theory is a framework that nurses use to prioritize client needs and
develop relevant nursing approaches. Maslow's model proposes that people are motivated to
meet their needs in an ascending order beginning with meeting basic survival needs. As essential
needs are satisfied, people move into higher psychosocial areas of development.
DIF: Cognitive Level: Application
REF: p. 10
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
11. Which of the following statements about communication theory is true?
a. Primates are able to learn new languages to share ideas and feelings.
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b. Concepts include only verbal communication.
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c. Perceptions are clarified through feedback.
d. Past experience does not influence communication.
ANS: C
Feedback is the only way to know that one’s perceptions about meanings are valid. Human
communication is unique. Only human beings have large vocabularies and are capable of
learning new languages as a means of sharing their ideas and feelings. Communication includes
language, gestures, and symbols to convey intended meaning, exchange ideas and feelings, and
to share significant life experience. To encode a message appropriately requires a clear
understanding of the receiver’s mental frame of reference (e.g., feelings, personal agendas, past
experiences) and knowledge of its purpose or intent of the communication.
DIF: Cognitive Level: Knowledge
REF: p. 7
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
12. In the circular transactional model of communication,
a. questions are framed in order to recognize the context of the message.
b. people take only complementary roles in the communication.
c. the context of the communication is unimportant.
d. the purpose of communication is to influence the receiver.
ANS: A
A circular model expands linear models to include the context of the communication, feedback
loops, and validation. With this model, the sender and receiver construct a mental picture of the
other, which influences the message and includes perceptions of the other person’s attitude and
potential reaction to the message.
DIF: Cognitive Level: Comprehension
REF: p. 8
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
13. The nurse recognizes that feedback loops
a. do not allow for correction of original information.
b. are solely based on the General Systems Theory.
c. do not allow for validation of information.
d. allow the human system to correct its original information.
ANS: D
Feedback (from the receiver or the environment) allows the system to correct or maintain its
original information. Feedback loops (from the receiver, or the environment) validate the
information, or allow the human system to correct its original information. General Systems
Theory, initially described by Ludwig von Bertalanffy (1968), focuses on process and
interconnected relationships comprising the “whole.”
DIF: Cognitive Level: Knowledge
REF: p. 8
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Psychosocial Integrity
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14. Which of the following statements best represents therapeutic communication when a student
discovers a client crying in bed?
a. “I am the nurse who will be doing your treatments today.”
b. “Will you listen to me so I can help you get better?”
c. “This is what is going to happen during surgery.”
d. “Can we talk about what seems to be bothering you?”
ANS: D
Asking about what is bothering the client is goal directed. Its purpose is to promote client wellbeing. “I am the nurse who will be doing your treatments today” is a statement of fact, and it
ignores the client’s emotional needs. “Will you listen to me so I can help you get better?” is not
goal directed and does not involve mutuality. “This is what is going to happen during surgery” is
simply one way. It does not engage the client in a therapeutic manner.
DIF: Cognitive Level: Application
REF: p. 10
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
15. The central constructs of person, environment, health, and nursing are found in all nursing
theories and models and are referred to as
a. telehealth.
b. the medical model.
c. nursing’s metaparadigm.
d. five core areas of competency.
ANS: C
Individual nursing theories represent different interpretations of the phenomenon of nursing, but
central constructs—person, environment, health, and nursing—are found in all theories and
models. They are referred to as nursing’s metaparadigm. These constructs are the
“metalanguage” of nursing, and together they act as basic building blocks for the discipline of
professional nursing. Telehealth is fast becoming an integral part of the health care system, used
both as a live interactive mechanism (particularly in remote areas, where there is a scarcity of
health care providers) and as a way to track clinical data. Two important outcomes are reduced
health costs and increased access to care. During the last century, the bulk of professional care
was delivered in acute care settings, based on the disease-focused medical model. Switching to
today’s community focus recognizes the fact that chronic medical conditions account for most of
today’s care, with most being treated in the community. The IOM report Health professions
education: A bridge to quality (2003) calls for the restructuring of clinical education responsive
to the 21st century health system transformation goals of providing the highest quality and safest
medical care possible. This report identified five core areas of competency required to cross the
bridge to quality.
DIF: Cognitive Level: Comprehension
REF: p. 4
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
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1. The discipline of nursing has “a unique perspective, a distinct way of viewing all phenomena,
which ultimately defines and limits the nature of its inquiry,” related to (Select all that apply.)
a. principles and laws that govern the life processes, well-being, and optimum
functioning of human beings, sick or well.
b. patterning of human behavior in interaction with the environment in critical life
situations.
c. processes by which positive changes in health status are affected.
d. processes by which negative changes in health status are affected.
e. patterning of human behavior in interaction with the environment in every life
situation.
f. principles and laws that govern the life processes, well-being, and optimum
functioning of human beings, in relation to wellness only.
ANS: A, B, C
Donaldson and Crowley characterize the discipline of nursing as having "a unique perspective, a
distinct way of viewing all phenomena, which ultimately defines and limits the nature of its
inquiry," related to "Principles and laws that govern the life processes, well-being, and optimum
functioning of human beings, sick or well; patterning of human behavior in interaction with the
environment in critical life situations; and processes by which positive changes in health status
are affected."
DIF: Cognitive Level: Application
REF: p. 2
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
Chapter 2: Professional Guides for Nursing Communication
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. The nurse demonstrates effective communication by ensuring all of the following except
a. two-way exchange of information among clients and health providers.
b. making sure that unilateral information is exchanged between clients and nurses.
c. making sure that the expectations and responsibilities of all are clearly understood.
d. recognizing that effective communication is an active process for all involved.
ANS: B
Effective communication is defined as a two-way exchange of information among clients and
health providers ensuring that the expectations and responsibilities of all are clearly understood.
It is an active process for all involved.
DIF: Cognitive Level: Knowledge
REF: p. 23
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Management of Care
2. A preoperative assessment shows that a client’s hemoglobin level is dropping. The anesthetist
orders 3 units of blood to be administered. The nurse administers the first unit before discovering
that the client is a Jehovah’s Witness, as documented in the record. This is an example of
a. professional conduct.
b. a negligent act.
c. physical abuse.
d. breaching client confidentiality.
ANS: B
The nurse was negligent by not checking the record and by failure to obtain written consent from
the client for the procedure. This is an example of misconduct, not professional conduct. The
nurse did not intend to physically harm the patient. The nurse did not breach client
confidentiality.
DIF: Cognitive Level: Application
REF: pp. 28-29
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. Which of the following is a violation of client confidentiality? Reporting
a. certain communicable diseases.
b. child abuse.
c. gunshot wounds.
d. client data to a colleague in a nonprofessional setting.
ANS: D
Releasing information to people not directly involved in the client’s care is a breach of
confidentiality. Certain communicable or sexually transmitted diseases, child and elder abuse,
and the potential for serious harm to another individual are considered exceptions to sharing of
confidential information.
DIF: Cognitive Level: Knowledge
REF: p. 37
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
4. A 16-year-old trauma victim arrives in the emergency department with a life-threatening
condition and requires emergency surgery. The nurse knows that
a. a parent/guardian must give consent.
b. the client can give consent if she provides proof of emancipation.
c. the client must first be evaluated for competency before obtaining consent.
d. surgery can be performed without consent.
ANS: D
Surgery can be performed without consent because it is a life-threatening emergency. Normally
parents or a guardian must give consent, but in a life-threatening emergency medical care can be
administered without consent. Providing proof of emancipation is not necessary in a lifethreatening situation. The client does not need to first be evaluated for competency in a life-
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threatening situation.
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DIF: Cognitive Level: Application
REF: p. 38
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
5. In regard to informed consent, which of the following statements is true?
a. Only legally incompetent adults can give consent.
b. Only parents can give consent for minor children.
c. It is not required that the client be told about costs and alternatives to treatment.
d. Consent must be voluntary.
ANS: D
For legal consent to be valid, it must be voluntary. Only legally competent adults can give
consent. Parents or legal guardians can give consent for minor children. Clients must have full
disclosure about risks/benefits, including costs and alternatives.
DIF: Cognitive Level: Knowledge
REF: p. 37
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. The client has a living will in which he states he does not want to be kept alive by artificial
means. The client’s family wants to disregard the client’s wishes and have him maintained on
artificial life support. The most appropriate initial course of action for the nurse would be to
a. tell the family that they have no legal rights.
b. tell the family that they have the right to override the living will because the
patient cannot speak.
c. report the situation to the hospital ethics committee.
d. allow the family to verbalize their feelings and concerns, while maintaining the
role of client advocate.
ANS: D
Allowing the family to verbalize their feelings and concerns is the most appropriate action at the
time to help the family deal with their loss and come to terms with their family member’s wishes.
Telling the family that they have no legal rights would not be supportive and might create
hostility. The family does not have the right to override a living will. It is not the most
appropriate initial course of action to report the situation to the hospital ethics committee.
According to the American Nurses Association Code of Ethics for Nurses, the nurse promotes,
advocates for, and strives to protect the health, safety, and rights of the patient.
DIF: Cognitive Level: Analysis
REF: p. 27
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Management of Care
7. The nurse collects both objective and subjective data. An example of subjective data is
a. BP 140/80.
b. skin color jaundiced.
c. “I have a headache.”
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d. history of seizures.
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ANS: C
Subjective data refers to the client’s perception of data and what the client or family says about
the data. Objective data refers to data that are directly observable or verifiable through physical
examination or tests. Blood pressure recording is objective. Jaundiced skin color observation by
the nurse is objective data. A history of seizures is objective data.
DIF: Cognitive Level: Knowledge
REF: p. 33
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity
8. The nurse observes a client pacing the floor. The nurse validates an inference when speaking to
the client by stating,
a. “You are anxious, so let’s talk about it.”
b. “Let’s try some deep breathing to help you relax.”
c. “You seem anxious. Will you tell me what is going on?”
d. “Clients who pace usually need to talk to a physician. Should I call yours?”
ANS: C
The nurse has inferred that the client is anxious but needs to ask further questions to validate the
information. A nurse should not make assumptions without first confirming that the inference is
correct. Deep breathing exercise is an intervention; it is not validating an inference.
DIF: Cognitive Level: Application
REF: p. 33
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
9. A client who is scheduled for a bilateral inguinal hernia repair the next day is observed pacing
the unit. After validating that the client is anxious about his upcoming surgery because he is
afraid of pain, a relevant nursing diagnosis would be
a. anxiety related to surgery.
b. pain related to anxiety about surgery as evidenced by pacing.
c. anxiety related to fear of postoperative pain as evidenced by pacing.
d. pacing related to fear of postoperative pain.
ANS: C
Anxiety is the problem to be addressed. Related to connects the problem to the etiology (fear of
pain). The third part of the statement identifies the clinical evidence (pacing) that supports the
diagnosis. There are three parts to a nursing diagnosis, and the anxiety is related specifically to
fear of pain after surgery. The problem to be addressed is the anxiety, not the pain, at this time.
“Pacing related to fear of postoperative pain” contains only two parts to this statement. Pacing is
the evidence, not the problem.
DIF: Cognitive Level: Application
REF: p. 33
TOP: Step of the Nursing Process: Nursing Diagnosis
MSC: Client Needs: Management of Care
10. Which of the following is an outcome for a client with a broken leg?
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a. Client will develop an ambulation program within 1 month.
b. Encourage client to ambulate with cast using crutches.
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c. Client asks, “When will I walk again?”
d. Client experiences alteration in mobility related to a broken leg.
ANS: A
Outcomes are goals that are measurable, achievable, and client centered. Ambulation is a nursing
intervention. A question from the client is not an outcome; it is a question. “Client experiences
alteration in mobility related to a broken leg” is part of a nursing diagnosis.
DIF: Cognitive Level: Application
REF: pp. 34-35
TOP: Step of the Nursing Process: Outcome Identification
MSC: Client Needs: Physiological Integrity
11. The nurse is teaching a client who is alert and oriented about the drug warfarin. When teaching
the client about this drug, the nurse emphasizes the need to be consistent with Vitamin K intake,
which is found primarily in green leafy vegetables. When the client’s spouse comes to visit, the
client states, “I can no longer consume green leafy vegetables.” This is an example of what type
of failure caused by a communication problem?
a. System failure
b. Reception failure
c. Transmission failure
d. Global aphasia
ANS: B
Communication problems occur when there are failures in one or more categories: the system,
the transmission, or in the reception. Reception failures occur when channels exist and necessary
information is sent, but the recipient misinterprets the message. System failures occur when the
necessary channels of communication are absent or not functioning. Transmission failures occur
when the channels exist but the message is never sent or is not clearly sent.
DIF: Cognitive Level: Analysis
REF: p. 23
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
12. When setting goals with a client, the nurse demonstrates which step of the nursing process?
a. Assessment
b. Planning
c. Implementation
d. Evaluation
ANS: B
Outcome identification occurs during the planning phase. Goals are identified during planning,
not assessment. Nursing interventions are performed during the implementation phase. During
evaluation, goal achievement is evaluated.
DIF: Cognitive Level: Knowledge
REF: p. 35
TOP: Step of the Nursing Process: Outcome Identification and Planning
MSC: Client Needs: Management of Care
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13. When the nurse identifies a health problem or alteration in a client’s health status that requires a
nursing intervention, the nurse is performing which step of the nursing process?
a. Diagnosis
b. Planning
c. Intervention
d. Evaluation
ANS: A
The nursing diagnosis consists of three parts: (1) problem, (2) etiology, and (3) evidence. The
problem is a statement identifying a health problem or alteration in a client’s health status
requiring nursing intervention. Planning occurs after problem identification. Interventions occur
during implementation. The effectiveness of the interventions is evaluated in the evaluation
phase.
DIF: Cognitive Level: Knowledge
REF: p. 33
TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Management of Care
14. When evaluating the client’s progress toward goal achievement, the nurse should ask which of
the following questions?
a. “Did the client tell the truth?”
b. “Were the goals realistic?”
c. “Did the physician diagnose the client’s condition correctly?”
d. “Was the length of stay too short?”
ANS: B
The goals need to be realistic and achievable in the time frame allotted for the interventions to be
effective. Validation of information occurs in the assessment phase. Medical diagnosis is not part
of the nursing process. The nurse needs to work within the time frame allotted.
DIF: Cognitive Level: Comprehension
REF: p. 34
TOP: Step of the Nursing Process: Evaluation
MSC: Client Needs: Management of Care
15. The plan of care serves as the structural framework for
a. maintaining confidentiality.
b. attaining self-actualization.
c. maintaining therapeutic communication.
d. providing safe, high-quality care.
ANS: D
The plan of care plan serves as the structural framework for providing safe, high-quality care. Its
purpose is to provide continuity and supply a basis for interventions and documentation of client
progress. Each plan of care should be individualized to reflect client values, clinical needs, and
preferences. Confidentiality is defined as providing only the information needed to provide care
for the client to other health professionals who are directly involved in the care of the client. The
nurse can use Maslow’s hierarchy of needs to prioritize goals and objectives. Therapeutic
communication helps the nurse use the nursing process.
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DIF: Cognitive Level: Comprehension
REF: p. 35
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
16. The nurse is caring for a client whose health has suddenly worsened. The nurse calls the health
care provider. What is the best example of the nurse communicating to the health care provider
using the situation part of SBAR communication?
a. “The patient has developed dyspnea with audible crackles in the lungs bilaterally;
oxygen saturation is 86% on room air.”
b. “The patient has chronic obstructive pulmonary disease due to a long-term history
of smoking.”
c. “I am concerned that the patient is exhibiting signs of a pulmonary embolus due to
a sudden drop in oxygenation.”
d. “I would like for you to order a STAT chest x-ray because the patient has suddenly
developed shortness of breath with hypoxia.”
ANS: A
Situation: What is going on with the client? Background: What is key information/context?
Assessment: What do I think the problem is? Recommendation: What do I want to be done?
DIF:
Cognitive Level: Analysis
REF: p. 24
TOP: Step of the Nursing Process: All phases of the nursing processMSC:
Client Needs: Management of Care
17. During a routine visit, the nurse notes that a child has several bruises at various stages of healing.
The child reports having fallen down. Failure to report these findings is an example of
a. negligence.
b. reasonable prudence.
c. maintenance of confidentiality.
d. HIPAA regulation.
ANS: A
Failing to report suspected physical or sexual child abuse is an example of a negligent act.
Reasonable prudence is a nursing action that a reasonably prudent nurse would perform. In a
situation where a child has several bruises, confidentiality must be breached. HIPAA regulations
protect the privacy of client records.
DIF: Cognitive Level: Application
REF: p. 37
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Management of Care
MULTIPLE RESPONSE
1. When practicing effective and correct communication, the nurse should (Select all that apply.)
a. speak in a clear voice.
b. be concise when providing client education.
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c. be concrete when communicating with clients.
d. focus entirely on abstract communication techniques with clients.
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e. ensure that communication with clients is complete.
f. provide courteous communication when interacting with clients.
ANS: A, B, C, E, F
Effective and correct communication is: clear, concise, concrete, complete, and courteous.
DIF: Cognitive Level: Analysis
REF: p. 23
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
Chapter 3: Clinical Judgment and Ethical Decision Making
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following types of thinking reflects the nursing process?
a. Habits
b. Inquiry
c. Mnemonic
d. Practice
ANS: B
More structured methods of thinking, such as inquiry, have been developed in disciplines related
to nursing. Repetitive practice does not reflect the nursing process. Memorizing does not reflect
the nursing process.
DIF: Cognitive Level: Knowledge
REF: p. 40
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. Which of the following personality characteristics is a barrier to critical thinking?
a. Accepting change
b. Being open minded
c. Stereotyping
d. Going with the flow
ANS: C
Stereotyping is a cognitive barrier to critical thinking because it interferes with the ability to treat
a client as an individual. Critical thinkers recognize that priorities change continually. Being
open minded is the ability to consider alternatives. Being flexible is a bridge to critical thinking,
not a barrier.
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DIF:
Cognitive Level: Comprehension
REF: p. 46
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TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. The ethical decision-making model where good is defined as maximum welfare or happiness is
known as the
a. utilitarian model.
b. human rights based model.
c. duty-based model.
d. Kant’s model.
ANS: A
The utilitarian model is also known as the goal-based model, where the duties of the nurse are
determined by what will achieve maximum welfare. In the human rights model, the client has
basic rights, including the right to refuse care. In the duty-based model, rightness is determined
by moral worth. The duty-based model is based on Kant’s philosophy.
DIF: Cognitive Level: Knowledge
REF: p. 41
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
4. Which of the following case examples represents the ethical concept of distributive justice?
a. A famous baseball player receives a heart transplant.
b. An older adult who has government insurance is denied standard cancer treatment.
c. During a visit to his physician’s office, a client demands antibiotics for his cold
and is given a prescription.
d. A client suffering from cirrhosis of the liver is placed on a transplant list.
ANS: B
The decision to deny expensive treatments or to deny acute care to clients older than a certain
age because of scarce treatment resources is an example of the concept of distributive justice. A
famous baseball player who receives a heart transplant could be an example of the concept of
social worth. A client demanding antibiotics for his cold during a physician’s office visit is an
example of the concept of unnecessary treatment. A client who suffers from cirrhosis and who is
placed on a transplant list is an example of justice, being fair or impartial.
DIF: Cognitive Level: Analysis
REF: pp. 43-44
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
5. Personal values are defined as
a. values shaped by family, religious beliefs, and years of experience.
b. altruism.
c. two values that are in conflict.
d. values determined by commitment.
ANS: A
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We all have a personal value system developed over a lifetime that has been extensively shaped
by our family, our religious beliefs, and our years of life experiences. Altruism is a core value of
professional nursing. Cognitive dissonance refers to two conflicting values. Value intensity refers
to the amount of an individual’s commitment to values.
DIF: Cognitive Level: Knowledge
REF: p. 46
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. A nurse values autonomy and self-determination as well as the preservation of life. This is an
example of
a. conceptions of the ideal.
b. cognitive dissonance.
c. operative values.
d. commitment.
ANS: B
Cognitive dissonance refers to the mental discomfort felt when there is a discrepancy between
what an individual already believes and some new information that does not go along with that
view. It refers to the holding of two or more conflicting values at the same time. Conceptions of
the ideal are conceived values. Operative values do not refer to conflicting values. Commitment
refers to value intensity.
DIF: Cognitive Level: Application
REF: p. 46
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
7. Which of the following statements is true about the critical thinking process?
a. It is a linear process.
b. The skills are inborn.
c. It is goal directed.
d. It assists nurses to criticize the health care system.
ANS: C
The process of critical thinking is systematic, organized, and goal directed. As critical thinkers,
nurses are able to explore all aspects of a complex clinical situation. Critical thinking is a circular
process. Critical thinking is a learned skill that teaches you how to “think about your thinking.”
Critical thinking is clinical judgment, not criticism.
DIF: Cognitive Level: Comprehension
REF: p. 49
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
8. Which of the following best describes the critical thinking skills of a novice nurse and an expert
nurse?
a. The expert nurse is able to diagnose faster than the novice nurse.
b. The expert nurse does not need to question and reassess like the novice nurse.
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c. The novice nurse uses past knowledge, whereas the expert nurse stays in the here
and now.
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d. The expert nurse organizes data more efficiently than the novice nurse.
ANS: D
The novice nurse collects lots of facts but does not logically organize them. Novice nurses tend
to jump too quickly to a diagnosis without recognizing the need to obtain more facts. The expert
nurse constantly questions and reassesses. The expert nurse compares new information with prior
knowledge, while the novice nurse makes fewer connections to past knowledge.
DIF: Cognitive Level: Comprehension
REF: p. 45
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
9. A client with schizophrenia has been stabilized on long-acting haloperidol, an antipsychotic
medication that is administered by injection every 3 weeks. The physician switches the
medication to Seroquel, a new antipsychotic oral medication that is administered twice a day.
The client complains that he cannot afford the new medication and will not be able to remember
to take it. The physician replies, “I can’t help that; I have to treat you the way I think is best.”
The client’s nurse may experience
a. paternalism.
b. cognitive dissonance.
c. nonmaleficence.
d. moral distress.
ANS: D
Moral distress results when the nurse knows what is right but is bound to do otherwise because
of legal or institutional constraints. Paternalism is making decisions for clients based on what is
thought best for them. Cognitive dissonance occurs when there are two conflicting values.
Nonmaleficence is avoiding actions that bring harm to another person.
DIF: Cognitive Level: Application
REF: p. 47
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
10. Characteristics of a critical thinker include all but which of the following?
a. Haphazardly seeking solutions
b. Anticipating consequences
c. Considering alternative solutions
d. Revising actions based on new input
ANS: A
This is an example of a negative style question. “Haphazardly seeking solutions” is correct
because a characteristic of a critical thinker is to systematically seek solutions, not to
haphazardly seek solutions. All of the other options are characteristics of a critical thinker.
DIF: Cognitive Level: Knowledge
REF: p. 45
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
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11. The best method for nurse educators to teach professional values is
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a.
b.
c.
d.
reading the ANA code.
laissez-faire.
role modeling.
values clarification.
ANS: C
Nursing education helps a nurse to acquire a professional value system. In nursing school, the
student nurse begins to take on some of the values of the nursing profession. Often, professional
values are transmitted by tradition in nursing classes and clinical experiences. They are modeled
by expert nurses and assimilated as part of the role socialization process during the years spent as
a student and new graduate. Professional values are stated in the ANA code, but the best way to
transmit them is by role modeling. Professional values are transmitted by tradition and
assimilated in the role socialization process. Values clarification helps a nurse to identify and
prioritize values.
DIF: Cognitive Level: Knowledge
REF: p. 49
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
12. Which of the following describes the first step in acquisition of a value?
a. There must be pride in and happiness with the choice.
b. The value must be acted upon in a pattern of behavior consistent with the choice.
c. The value should be the result of conscious choice.
d. The value must be chosen after careful consideration of each alternative.
ANS: C
Professional values acquisition should be the result of conscious choice. This is the first step in
values acquisition. The value must be acted upon in a pattern of behavior consistent with the
choice, which occurs during the seventh criteria for acquisition of a value. Pride and happiness
with the choice occurs during the fourth criteria for acquisition of a value. Careful consideration
of each alternative occurs during the third criteria for acquisition of a value.
DIF: Cognitive Level: Knowledge
REF: p. 49
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
13. The client’s values
a. must coincide with those of the nurse.
b. are only considered during assessment.
c. influence the nurse’s interventions.
d. are not influenced by culture.
ANS: C
In the planning phase, it is important to identify and understand the client’s value system as the
foundation for developing the most appropriate interventions. It is not necessary for the client
and nurse’s values to coincide; in fact, it is an unrealistic expectation. The client’s value system
is important to consider throughout the nursing process. Values are influenced by culture and
religious beliefs.
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DIF: Cognitive Level: Comprehension
REF: p. 51
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
14. Values clarification can be incorporated within the intervention phase of the nursing process by
a. identifying ineffective family coping.
b. identifying care guidelines.
c. identifying client’s values.
d. identifying specific nursing diagnoses.
ANS: B
Plans of care that support rather than discount the client’s health care beliefs are more likely to
be received favorably. Your interventions include values clarification as a guideline for care.
Ineffective family coping is a nursing diagnosis, not an intervention. Values are identified and
then used as care guidelines. Nursing diagnosis does not occur during the intervention phase of
the nursing process.
DIF: Cognitive Level: Comprehension
REF: p. 51
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Management of Care
15. During the third step in the critical thinking process
a. new data are obtained.
b. values are clarified.
c. existing information is compared with past knowledge.
d. the problem is identified.
ANS: C
During step 3, existing information is compared with past knowledge. New data are obtained in
step 4. Values are clarified in step 2. The problem is identified in step 5.
DIF: Cognitive Level: Comprehension
REF: p. 51
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
16. The student nurse can best learn the steps in critical thinking through
a. reading journals.
b. classroom instruction.
c. repeated practice.
d. developing a mnemonic.
ANS: C
The most effective method of learning the steps in critical thinking is by repeatedly applying
them to clinical situations. Reading journals, classroom instruction, and developing a mnemonic
are not the most effective ways of learning the steps in critical thinking.
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DIF: Cognitive Level: Application
REF: p. 54
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
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17. The bioethical principle of autonomy refers to
a. the client’s right to self-determination.
b. avoiding actions that bring harm to another person.
c. a decision resulting in the greatest good or least harm.
d. being fair or impartial.
ANS: A
Autonomy is the client’s right to self-determination. Avoiding actions that bring harm to another
person refers to the principle of nonmaleficence. A decision resulting in the greatest good or least
harm refers to the principle of beneficence. Being fair or impartial refers to the principle of
justice.
DIF: Cognitive Level: Knowledge
REF: p. 42
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
MULTIPLE RESPONSE
1. Which of the following is true about critical thinkers? (Select all that apply.)
Critical thinkers
a. are open minded.
b. are able to consider alternatives.
c. use a purposeful reasoning process.
d. use a linear thinking process.
e. are able to recognize information gaps.
ANS: A, B, C, E
Critical thinkers use specific thinking skills that are not rigid, and these allow the consideration
of alternatives and recognition of gaps and available information. Critical thinkers do not use a
linear process but constantly add new input.
DIF: Cognitive Level: Knowledge
REF: p. 45
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
Chapter 4: Clarity and Safety in Communication
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
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1. A nurse manager is teaching a group of nurses about client safety. The nurse manager teaches the
nurses that safety is defined as “avoidance, prevention, and amelioration of adverse outcomes or
injuries stemming from the process of health care itself.” What is the source of this definition?
a. Hippocratic oath
b. National Patient Safety Foundation
c. American Association of Colleges of Nursing
d. American Nurses Association’s Code of Ethics
ANS: B
The National Patient Safety Foundation defines safety as “avoidance, prevention, and
amelioration of adverse outcomes or injuries stemming from the process of healthcare itself.”
DIF: Cognitive Level: Application
REF: p. 58
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. When conducting an in-service on serious medical errors, the nurse teaches that nearly 70% of
sentinel events are related to
a. lack of education.
b. inadequate resources.
c. minimal rest periods.
d. miscommunication.
ANS: D
Multiple studies have pinpointed miscommunication as a major causative agent in sentinel
events, that is, errors resulting in unnecessary death and serious injury. Miscommunication is the
root cause in nearly 70% of sentinel events.
DIF: Cognitive Level: Application
REF: p. 58
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. When working on a nursing unit, the nurse recognizes that incomplete communication errors
most often occur during
a. staff meetings.
b. the night shift.
c. a handoff procedure.
d. medication administration.
ANS: C
It is estimated that 70% of reported errors are preventable. "Preventable" means the error occurs
through a medical intervention, not because of the client's illness. Fatigue is repeatedly cited as a
factor contributing to errors. The most common cause of error is incomplete communication
during the very many ‘handoffs’ transferring responsibility for client care to another care
provider, another unit, or agency. It is estimated that in 1 day a client may experience up to 8
handoffs.
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DIF: Cognitive Level: Application
REF: p. 58
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Management of Care
4. A student nurse is learning about how to reduce errors and increase safety. The nursing instructor
recognizes that further teaching is warranted when the student nurse states which of the
following?
a. “When communicating with clients, I will be clear.”
b. “I will be timely in my communication with clients.”
c. “I will promote communication with clients that is ambiguous.”
d. “When communicating with clients, I will ensure the client understood.”
ANS: C
Standardization of communication is an effective tool to avoid incomplete or misleading
messages. Standardization needs to be institutionalized at the system level and implemented
consistently at the staff level. Safe communication about client care matters needs to be clear,
unambiguous, timely, accurate, complete, open, and understood by the recipient to reduce errors.
DIF: Cognitive Level: Application
REF: p. 62
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
5. The nurse manager sets a goal to establish a new safety culture on a hospital unit. The nurse
manager recognizes that basic components in establishing a new safety culture include
a. support of effective health care teamwork.
b. encouragement of individualism.
c. discouragement of new concepts.
d. promotion of a hierarchical system.
ANS: A
A major international effort is underway to prioritize safety goals by improving communication
about clients among his or her various providers. The aim is to reduce client mortality, decrease
medical errors, and promote effective health care teamwork.
DIF: Cognitive Level: Application
REF: p. 61
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. A nurse attends an in-service aimed to educate staff about reporting hospital errors. The nurse
demonstrates understanding when listing which of the following as consistent with error
reporting within the United States?
a. Error reporting is transparent
b. Errors are overreported
c. Errors are underreported
d. Providers are not concerned about consequences of reporting errors
ANS: C
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Providers are concerned about negative consequences of disclosing errors, such as malpractice
litigation, reputation damage, job security, and personal feelings such as loss of self-esteem,
among others. This has led to serious underreporting. In the United States, according to IOM,
only a tiny fraction of unsafe care incidents are reported. Some estimate that more than 90% of
errors go unreported.
DIF: Cognitive Level: Application
REF: p. 59
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
7. When educating a newly diagnosed client about management of diabetes mellitus, the nurse
recognizes that health care–related communication
a. does not lead to errors within the hospital.
b. is generally well understood by most clients.
c. is not an important component of client care.
d. can cause clients to misunderstand information.
ANS: D
It is important to make verbal and written information as simple as possible. Nurses need to
assess the health literacy level of each client. Nurses should provide privacy to avoid
embarrassment and obtain feedback or “teach-backs” to determine the client's understanding of
teaching: Simplify, Clarify, Verify!
DIF: Cognitive Level: Application
REF: p. 72
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
8. A nurse manager encourages staff to improve error and near miss event reporting. The nurse
manager recognizes that as error reporting improves,
a. the severity of errors increases.
b. better, safer systems can be developed.
c. the likelihood of other errors increases.
d. error detection rates and severity remain unchanged.
ANS: B
Adequate error and near miss event reporting are necessary to designing better, safer systems.
Failure to report and track errors and near misses actually increases the likelihood of other errors.
DIF: Cognitive Level: Application
REF: p. 59
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
9. When educating a student nurse about safety communication improvement solutions, the nursing
instructor recognizes that additional teaching is warranted when the student nurse lists which of
the following as a safety communication improvement solution?
a. Adopting technology-oriented tools
b. Using standardized verbal and electronic communication tools
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c. Disempowering clients to be partners in safer care
d. Participating in team training communication seminars
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ANS: C
While a nurse’s clinical judgment remains a valid, essential aspect of communication, other
safety communication improvement solutions include using standardized verbal and electronic
communications tools, participating in team-training communication seminars, adopting
technology-oriented tools, and empowering clients to be partners in safer care. Communication
that promotes client safety needs to include both communication of concise critical information
and active listening.
DIF: Cognitive Level: Application
REF: p. 65
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
10. The nurse is teaching the student nurse about how to use SBAR when calling a physician. The
student nurse verbalizes understanding of SBAR when stating that SBAR is
a. used as a situational briefing.
b. utilized strictly within the hospital setting.
c. not used in e-mails due to HIPAA rules.
d. never recorded within the client’s chart.
ANS: A
SBAR is used as a situational briefing, so the team is "on the same page." It is used across all
types of agencies, groups, and even in e-mails. SBAR simplifies verbal communication between
nurses and physicians because content is presented in an expected format. Some hospitals use
laminated SBAR guidelines at the telephones for nurses to use when calling physicians about
changes in client status and requests for new orders. Documenting the new order is the only part
of SBAR that gets recorded.
DIF: Cognitive Level: Application
REF: p. 66
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
11. A nurse recognizes that strategies for clear, accurate communication to promote client safety
include which of the following?
a. Establishing a safe environment
b. Maintaining a climate of closed communication
c. Using unique interdisciplinary communication tools
d. Using communication tools that promote vague communication
ANS: A
Clear, accurate communication is the bedrock of safe care. Accurate, clear communication and
best practice are indicators of quality of care and serve to maintain a safe environment.
DIF: Cognitive Level: Application
REF: p. 57
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
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12. When calling a physician, the nurse tells the physician her name, what unit and what hospital she
is calling from, the client’s name, and that the client is having trouble breathing. The nurse is
demonstrating which step in the SBAR format for communicating with a client’s physician?
a. Situation
b. Assessment
c. Background
d. Recommendation
ANS: A
An example of the situation component of SBAR reporting is: “Dr. Preston, this is Wendy Obi,
evening nurse on 4G at St. Simeon Hospital, calling about Mr. Lakewood, who’s having trouble
breathing.” An example of the assessment component of SBAR reporting is: “I don’t hear any
breath sounds in his right chest. I think he has a pneumothorax.” An example of the background
component of SBAR reporting is: “Kyle Lakewood, DOB 7/1/60, a 53-year-old man with
chronic lung disease, admitted 12/25, who has been sliding downhill × 2 hours. Now he’s
acutely worse: VS heart rate 92, respiratory rate 40 with gasping, B/P 138/94, oxygenation down
to 72%.” An example of the recommendation component of SBAR reporting is: “I need you to
see him right now. I think he needs a chest tube.”
DIF: Cognitive Level: Application
REF: p. 66
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
13. The nurse is caring for a client who is becoming increasingly short of breath. The nurse decides
to call the physician. Which of the following should the nurse initially do when speaking with the
physician?
a. State the problem
b. Tell what is needed
c. State the client’s allergies
d. Relate the client’s background
ANS: A
During the situation component of SBAR, the nurse identifies herself, the client, and the
problem. During the recommendation component of SBAR, the nurse tells what is needed.
During the background component of SBAR, the nurse relates the client’s background.
DIF: Cognitive Level: Application
REF: p. 66
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
14. When communicating with a client’s physician, the nurse suggests ordering a STAT chest x-ray
for a client who is experiencing dyspnea. This is an example of which component of the SBAR
format for communicating with the client’s physician?
a. Situation
b. Assessment
c. Background
d. Recommendation
ANS: D
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During the recommendation component of SBAR, the nurse states an informed suggestion for
the continued care of the client by proposing an action and stating what is needed and in what
time frame it needs to be completed. During the situation component of SBAR, the nurse
identifies herself, the client, and the problem. During the assessment component of SBAR, the
nurse states a conclusion that is based on what she thinks is wrong. During the background
component of SBAR, the nurse relates the client’s background.
DIF: Cognitive Level: Application
REF: p. 66
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
15. When a night shift nurse completes a shift, she gives a report about her clients to the oncoming
day shift nurse. When beginning the report, the night shift nurse introduces herself and states her
role, states the client’s name, identifiers, age, sex, and location. Which of the following should
the nurse do next?
a. State critical lab reports, allergies, and alerts
b. List current medications and client’s family history
c. Talk about any anticipated changes in the plan of care
d. Relate client’s chief complaint, vital signs, symptoms, and diagnosis
ANS: D
When using the acronym “I PASS the BATON,” the nurse should first introduce herself and state
her role; then state the client’s name, identifiers, age, sex, and location; and then go over the
client’s assessment, including the chief complaint, vital signs, symptoms, and diagnosis.
The fifth step in “I PASS the BATON” is safety concerns, which include critical lab reports,
allergies, and alerts. The sixth step in “I PASS the BATON” is background, which includes
comorbidities, previous episodes, current medications, and family history. The final step in “I
PASS the BATON” is next, in which the plan is stated, including what will happen next, and
includes any anticipated changes.
DIF: Cognitive Level: Application
REF: p. 69
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
16. When using the acronym “I PASS the BATON,” the nurse demonstrates understanding by
beginning with an introduction; then stating the client’s name, identifiers, age, sex, and location;
then discussing the assessment of the client; and then talking about
a. safety concerns related to the client.
b. the situation, including current status.
c. a summary of the client’s medications.
d. a synopsis of the client’s psychosocial needs.
ANS: B
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After assessment, the next step using the acronym “I PASS the BATON” is situation, which
includes current status, level of certainty, recent changes, and response to treatment. When using
the acronym “I PASS the BATON,” safety concerns comes immediately after situation. A
summary of the client’s current medications occurs during the background step when using the
acronym “I PASS the BATON.” A synopsis of the client’s psychosocial needs is not part of the
acronym “I PASS the BATON.”
DIF: Cognitive Level: Application
REF: p. 69
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
MULTIPLE RESPONSE
1. When educating staff about how to reduce errors and increase safety, the nurse manager
emphasizes the importance of communication that is (Select all that apply.)
a. clear.
b. vague.
c. timely.
d. accurate.
e. unambiguous.
ANS: A, C, D, E
Changes in communication to reduce errors and increase safety need to be institutionalized at the
system level and implemented consistently at the staff level. Safe communication about client
care matters needs to be clear, unambiguous, timely, accurate, complete, open, and understood by
the recipient to reduce errors. Safe communication about client matters should be clear, not
vague.
DIF: Cognitive Level: Application
REF: p. 62
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. The nurse manager is educating the unit staff about ways to promote safer clinical practice. The
nurse manager emphasizes that this can be done through the incorporation of which of the
following? (Select all that apply.)
a. Correlation
b. Cooperation
c. Collaboration
d. Cultural sensitivity
e. Communication clarity
ANS: B, C, E
Beyond individual changes to create safer climates for our clients, we need to advocate for
organizational system changes. Leadership is needed to incorporate the “3 Cs,” which promote
safer clinical practice:
• Communication clarity
• Collaboration
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• Cooperation
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DIF: Cognitive Level: Application
REF: p. 60
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
Chapter 5: Developing Therapeutic Communication Skills
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. When therapeutically communicating with a client who has just found out he is HIV- positive,
the nurse should focus on
a. professional needs.
b. an unlimited time frame for communication.
c. verbal communication only between the client and the nurse.
d. achieving identified health-related goals.
ANS: D
Therapeutic communication is defined as a dynamic interactive process consisting of words and
actions and entered into by a clinician and client for the purpose of achieving identified healthrelated goals. Originally conceptualized by Jurgen Ruesch in 1961, communication skills are
essential drivers for developing therapeutic relationships and facilitating interdisciplinary
collaborative communication with clients and families. Fundamental forms of health
communication include verbal and written words and nonverbal communicative behaviors.
DIF: Cognitive Level: Application
REF: p. 75
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. The nurse demonstrates understanding of the concept of metacommunication through
a. recognizing the impact of communication on others.
b. actively listening with good eye contact.
c. implementing barriers to effective communication.
d. ensuring that verbal and nonverbal messages are incongruent.
ANS: B
Metacommunication refers to how nonverbal cues are used to enhance or negate the meaning of
words. In addition to observable nonverbal behavior, client choices about clothing, personal and
religious items, hairstyle and hygiene, and voluntary use of gestures inform, add to, and complete
verbal messages. Behavioral communication is influenced by life circumstances, culture, and
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immediate context, so it is susceptible to misinterpretation and requires validation.
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DIF: Cognitive Level: Application
REF: p. 76
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. When communicating with a client, the nurse recognizes that a barrier to effective
communication is
a. cultural sensitivity.
b. thinking ahead to the next question.
c. completion of physical care in a nonhurried manner.
d. focusing on the current questions asked by the client.
ANS: B
Barriers to effective communication within the nurse occur when the nurse is not fully engaged
with the client because of thinking ahead to the next question; when the nurse has cultural
stereotypes and biases; and when the nurse is in a hurry to complete physical care.
DIF: Cognitive Level: Application
REF: p. 79
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
4. When communicating with clients, the nurse actively uses listening responses. Which of the
following types of listening response should the nurse use?
a. Moralizing
b. Giving advice
c. False reassurance
d. Paraphrasing
ANS: D
Paraphrasing is an example of a listening response that focuses on the client. Moralizing, giving
advice, and false reassurances are all examples of negative listening responses.
DIF: Cognitive Level: Comprehension
REF: p. 86| p. 88
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. The nurse enters a client’s room with the intent of allowing the client to express feelings in
relation to her new cancer diagnosis. The nurse notices that the client is crying and guarding her
incision site. After validating physical discomfort, the nurse should
a. administer an analgesic and postpone the interaction.
b. sit with the client and hold her hand.
c. explain that pain is expected following surgery but that it is important to increase
activity to avoid complications.
d. acknowledge the physical pain but state that it is a priority to immediately address
the emotional pain.
ANS: A
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Communication breaks down when the nurse and client do not share the same understanding of
messages. Barriers to effective communication occur in clients when they are preoccupied with
pain, physical discomfort, worry, or contradictory personal beliefs. The client’s pain must be a
priority for the nurse before other needs are addressed.
DIF: Cognitive Level: Analysis
REF: p. 78
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. A nurse is conducting a medication education group for mentally ill clients. One of the clients
states, “I don’t think everyone needs medications. What about psychotherapy? Can you tell me
about that?” What is an appropriate response by the nurse?
a. Talk to the group about the benefits of psychotherapy.
b. Tell the group that psychotherapy is ineffective and they need medication.
c. Acknowledge the question, but explain the time limitations and focus of that
particular group.
d. Explain that it is the physician’s decision what type of treatment modality is for
each client
ANS: C
In the past, nurses had more time with clients. Today nurses must make every second count.
Nurses and clients need to select the most pressing health care needs for attention. The nurse
should focus on what is essential to know, rather than what might be nice to know. This requires
planning and sensitivity to client needs and preferences. Client readiness and capabilities are
other factors to take into consideration in selecting content. Unless it is an emergency situation,
the nurse can guide but not insist on a particular point of discussion.
DIF: Cognitive Level: Application
REF: p. 92
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
7. When teaching a client how to administer insulin, the nurse recognizes that the best method of
communicating therapeutically with the client is to
a. talk to the client in the visitors’ lounge.
b. talk to the client within his personal space.
c. communicate with the client using touch.
d. face the client while leaning slightly forward.
ANS: D
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Privacy, space, and timing are other aspects to consider. Clients need privacy, to be free from
interruption, and to have their space requirements respected to fully engage in meaningful
conversations. Therapeutic conversations typically take place within a social distance (3-4 feet is
optimal). Touch has contextual and cultural meanings. Women are more likely to welcome and
use touch in communication. Touch is a valued form of communication in some cultures. In
others, touch is reserved for religious purposes or is seldom used as a form of communication,
for example in Asia. Before touching a client, assess the client's receptiveness to touch.
Observing the client will provide some indication, but you may need to ask for validation. If the
client is paranoid, out of touch with reality, verbally inappropriate, or mistrustful, touch is
contraindicated as a listening response. Minimal physical cues (e.g., leaning towards the client,
nodding, smiling) are used to accentuate words and to connect with people nonverbally as well
as verbally.
DIF: Cognitive Level: Application
REF: p. 76
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
8. When conducting an assessment interview, which of the following is the best communication
technique for the nurse to use?
a. Ask multiple questions at the same time
b. Offer limited time for the client to respond to each question that is asked
c. Use short, unambiguous listening responses focused on current health issues and
client concerns
d. Ensure that all questions are answered immediately in order to avoid the need for
related follow-up questions to clarify
ANS: C
A client-centered interview begins with encouraging clients to tell the story of their illness. This
format helps nurses integrate personal with medical perspectives. Using short, unambiguous
listening responses focused on current health issues and client concerns is the best means of
helping clients tell their story. With relevant queries you will get a better idea of how the client
communicates and what clients consider most important about their clinical situation. In addition
to using a “here and now” approach, avoid asking more than one question at a time, and allow
enough time for the client to fully answer. Related follow-up questions to clarify or help clients
expand on what has been introduced can be helpful.
DIF: Cognitive Level: Application
REF: p. 82
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
9. The nurse asks a newly admitted client, “Can you tell me what brought you to the hospital
today?” The purpose of an open-ended question is to
a. influence the direction of an acceptable response.
b. encourage the client to answer the question with a one-word response.
c. allow clients latitude in telling their story.
d. allow the client to engage in a passive relationship with the nurse.
ANS: C
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Open-ended questions permit clients to express health problems and needs in their own words.
They are especially helpful at the start of a relationship, when the nurse’s objective is to gather
information and to get to know the client as a person. You are more likely to elicit a client’s
values, preferences, and ways of thinking about their illness if you allow them latitude in telling
their story through open-ended questions. Sharing the personal meanings of an illness rather than
identifying a diagnosis or listing discrete symptoms helps the client and nurse link the context of
a health disruption with symptoms and provides more complete information. An open-ended
question is similar to an essay question on a test. It is open to interpretation and cannot be
answered by “yes,” “no,” or a one-word response. Open-ended questions ask clients to think and
reflect on their situation. They help connect relevant elements of the client's experience without
influencing the direction of the response. (e.g., relationships, impact of the illness on self or
others, environmental barriers, potential resources). Open-ended questions are used to elicit the
client's thoughts and perspectives without influencing the direction of an acceptable response.
DIF: Cognitive Level: Application
REF: p. 82
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
10. Which of the following is the best questioning sequence during a client interview in which the
client is communicative and not in an emergency situation?
a. Begin with focused questions and proceed to open-ended questions.
b. Begin with open-ended questions and proceed to focused questions.
c. Begin with closed questions and proceed to open-ended questions.
d. Begin with open-ended questions and proceed to closed questions.
ANS: B
Start with open-ended questions to allow the client to tell his or her story in his or her own way
to obtain general information. Use focused questions to obtain more specific information Start
with open-ended, not focused or closed, questions. Proceed to focused questions, not closed
questions.
DIF: Cognitive Level: Application
REF: pp. 82-83
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
11. A client is admitted to the hospital for unsteady gait resulting in frequent falls. Which of the
following is a circular question that the nurse could ask this client?
a. “Tell me more about your falls at home.”
b. “How will this hospitalization affect your family?”
c. “Have you experienced dizziness and imbalance before?”
d. “Can you tell me what brought you here?”
ANS: B
Circular questions are a form of focused questions, which give attention to the interpersonal
context in which an illness occurs. These are used to explore the impact of a health disruption on
family functioning and relationships with significant others. “Tell me more about your falls at
home” is a focused question. “Have you experienced dizziness and imbalance before?” is a
closed-ended question. “Can you tell me what brought you here?” is an open-ended question.
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DIF: Cognitive Level: Application
REF: p. 83
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
12. A client states, “I can’t sleep all night because the nurses are noisy.” Which of the following
responses by the nurse best represents the nurse’s recognition of the client’s theme?
a. “I will speak to the supervisor about your complaint.”
b. “You cannot sleep because of the noise level at night?”
c. “You need to understand that nurses communicate with other clients during the
night.”
d. “I will tell the night nurses that you complained.”
ANS: B
Listening for themes requires observing and understanding what the client is not saying, as well
as what the person actually reveals. Identifying the underlying themes presented in a therapeutic
conversation can relieve anxiety and provide direction for individualized nursing interventions.
Speaking to a supervisor, explaining that nurses communicate with other clients during the night,
and telling the night nurse of the complaint are actions by the nurse, not identification of themes.
DIF: Cognitive Level: Application
REF: pp. 83-84
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
13. A client states, “I don’t know about taking this medicine the doctor is putting me on. I’ve never
had to take medication before, and now I have to take it twice a day.” The nurse’s response is, “It
sounds like you don’t know what to expect from taking the medication.” The nurse’s response is
an example of which of the following?
a. Clarification
b. Paraphrasing
c. Restatement
d. Validation
ANS: B
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Paraphrasing is a listening response, which focuses on the cognitive component of a message. It
is used to check whether the nurse's translation of the client's words represents an accurate
interpretation of the message. The strategy takes the essential information expressed in the
client's original message and presents it in a shorter, more specific form, without losing its
meaning. The focus is on the core elements of the original statement: “In other words, what I
think I hear you saying is,” or “let me understand, are you saying that….?” Clarification is a
listening response, used to ask clients for more information or for elaboration on a point. The
strategy is useful when parts of a client's communication are ambiguous or not easily understood.
Failure to ask for clarification when part of the communication is poorly understood means that
the nurse will act on incomplete or inaccurate information. For example, you could say, “May I
tell you what I have understood so far, and see if you think I understand your situation?
Restatement is an active listening strategy used to broaden a client's perspective or provide a
sharper focus on a specific part of the communication. Restating a self-critical or irrational part
of the message in a questioning manner focuses the client's attention on the possibility of an
inaccurate or global assertion. Restatement is particularly effective when the client
overgeneralizes or seems stuck in a repetitive line of thinking. To challenge the validity of the
client's statement directly could be counterproductive, whereas repeating parts of the message in
the form of a query serves a similar purpose without raising defenses; for example, “Let me see
if I have this right…”
Validation is a special form of feedback, used to ensure that both participants have the same
basic understanding of messages. Simply asking clients whether they understand what was said
is not an adequate method of validating message content. Validation can provide new
information that helps the nurse frame comments that match the client's need.
DIF: Cognitive Level: Application
REF: pp. 87-88
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
14. The student nurse is working on an assignment in which she has to interview a fellow student
nurse for 30 minutes. The fellow student nurse talks about career plans, possible jobs after
graduation, and her part-time work. After 10 minutes, she has stopped talking and both student
nurses sit in silence. Which of the following is the best response by the interviewing student
nurse?
a. “Tell me more about how you selected your career goals.”
b. “Who is the most significant person in your life?”
c. “What impact will these plans have on your life?”
d. Remain silent until the fellow student nurse breaks the silence.
ANS: C
An open-ended question is usually just the introduction, requiring further dialogue about relevant
topics. Ending the dialogue with a general open-ended question such as, “Is there anything else
that is concerning you right now?” can provide relevant information that might otherwise be
overlooked. Asking a focused question allows the interviewer to obtain more specific
information. “Who is the most significant person in your life” is a closed-ended question that is
limiting. A silent pause can be helpful, but long silences can become uncomfortable.
DIF: Cognitive Level: Application
REF: pp. 82-83
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Psychosocial Integrity
15. As the nurse communicates with a client, the feedback provided by the nurse should be
a. descriptive, general, and content focused.
b. client focused and evaluative.
c. well-timed and general.
d. specific and focused on observed behavior.
ANS: D
Feedback is a response message related to specific client behaviors and words. Nurses give and
ask for client feedback to ensure mutual understanding. Feedback can focus on the content, the
relationship between people and events, the feelings generated by the message, or parts of the
communication that are not clear. Feedback should be specific and focused on observed
behavior. Analyzing a client's motivations make clients defensive. Feedback should be a two-way
process. Feedback responses reassure the client that the nurse is fully attentive to what the client
is communicating. When it offers a neutral mirror, clients are able to view a problem or behavior
from a different perspective. Feedback is most relevant when it only addresses the topics under
discussion and doesn’t go beyond the data presented by the client. Feedback provided to nurses
about their health teaching helps them to individualize teaching content and methodology to
better facilitate the learning process.
DIF: Cognitive Level: Knowledge
REF: p. 92
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
16. A client tells the nurse, “I am having a tough time and I am scared about the future.” Which of
the following responses by the nurse is the best feedback?
a. “I know what you mean.”
b. “You should do something about it.”
c. “I really don’t think you are having a tough time.”
d. “You are having a tough time and you are scared.”
ANS: D
Feedback is a response message related to specific client behaviors and words. Nurses give and
ask for client feedback to ensure mutual understanding. Feedback can focus on the content, the
relationship between people and events, the feelings generated by the message, or parts of the
communication that are not clear. Feedback should be specific and focused on observed
behavior. Analyzing a client's motivations make clients defensive. Feedback should be a two-way
process. Feedback responses reassure the client that the nurse is fully attentive to what the client
is communicating. When it offers a neutral mirror, clients are able to view a problem or behavior
from a different perspective. Feedback is most relevant when it only addresses the topics under
discussion, and doesn’t go beyond the data presented by the client. Feedback provided to nurses
about their health teaching helps them to individualize teaching content and methodology to
better facilitate the learning process. “I know what you mean” is disconfirming. “You should do
something about it” and “I really don’t think you are having a tough time” are examples of
responses that are judging or evaluating.
DIF:
Cognitive Level: Application
REF: p. 92
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TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
17. When caring for a hospitalized client, the nurse demonstrates effective communication when
a. presenting several ideas at a time.
b. using vocabulary that is unfamiliar to the client.
c. stating key ideas only once.
d. putting ideas in a logical sequence of related material.
ANS: D
Guidelines to effective verbal communication in the nurse-client relationship include putting
ideas in a logical sequence of related material, focusing only on essential elements and
presenting one idea at a time, keeping language as simple as possible through using vocabulary
familiar to the client, and repeating key ideas.
DIF: Cognitive Level: Application
REF: p. 92
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
18. Which of the following is true in relation to the use of humor?
a. Humor is most effective when building rapport.
b. Humor should focus on the client’s personal characteristics.
c. Humor and laughter have healing purposes.
d. Humor should dominate the situation.
ANS: C
Humor and laughter have healing purposes. Laughter generates energy, and activates bendorphins, a neurotransmitter that creates natural highs and reduces stress hormones. Humor is
most effective when rapport is well established and a level of trust exists between the nurse and
client. When humor is used, it should focus on the idea, event, or situation, or something other
than the client’s personal characteristics. Humor should fit the situation, not dominate it.
DIF: Cognitive Level: Knowledge
REF: pp. 94-95
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
Chapter 6: Variation in Communication Styles
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Arnold: Interpersonal Relationships, 7th Edition
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MULTIPLE CHOICE
1. Which of the following is a description of metacommunication?
a.
Communication style
b.
Nonverbal communication
c.
Verbal communication
d.
Nonverbal and verbal
communication
ANS: D
Metacommunication is a broad term used to describe all of the factors that
influence how the message is perceived. It is a message about how to
interpret what is going on. Metacommunicated messages may be hidden
within verbalizations or be conveyed as nonverbal gestures and expressions.
Communication style refers to the manner in which one communicates.
Nonverbal style includes facial expression, gestures, body posture, etc.
Verbal style includes pitch, tone, and frequency.
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: All phases
p. 100
MSC: Client Needs: Psychosocial Integrity
2. The nurse puts his arm around an older adult client when assisting her to
transfer to a chair. The client could interpret the nurse’s touch as
a.
a positive gesture only.
b.
a threat.
c.
denotation.
d.
paralanguage.
ANS: A —> B
Touching a client is one of the most powerful ways a nurse has to
communicate nonverbally. Within a professional relationship, affective touch
can convey caring and reassurance. In studies, nurses’ touching clients has
been reported to be perceived both positively as an expression of caring and
negatively as a threat. Denotation refers to the generalized meaning of a
word. Paralanguage is the way a verbal message is expressed.
DIF: Cognitive Level: Application REF: p. 103
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
3. A description of denotation is
a.
b.
a personalized meaning of a word
or phrase.
a generalized meaning assigned
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c.
d.
to a word.
a meaning shared by families.
a meaning generally shared
within a specific culture.
ANS: B
Denotation refers to the generalized meaning assigned to a word.
Connotation refers to a personalized meaning of a word. Jargon or slang is
referred to a meaning generally shared within a specific culture.
DIF: Cognitive Level: Knowledge REF: p. 101
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
4. When communicating about a client with a health care provider from another
culture, the nurse states, “The client stopped taking his medications last
week when he fell off the wagon.” The health care provider looks at the
nurse blankly. This is an example of
a.
connotation.
b.
information processing.
c.
time span between messages.
d.
nonverbal cultural variations.
ANS: A
Connotation refers to the use of words in a personalized way that is culturally
specific. Processing is not the problem; the health care provider requires an
explanation of the meaning. The health care provider does not need more
time to translate the message. This is an example of connotation, not
nonverbal communication.
DIF: Cognitive Level: Application REF: p. 101
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. The nurse is assigned to care for a client who has been diagnosed with
multiple sclerosis. Which communication behavior will have the most impact
on the client?
a.
What is said
b.
Tone of voice
c.
Sense of confidence
d.
Verbal message
ANS: B
The oral delivery of a verbal message, expressed through tone of voice,
inflection, sighing, and so on, is referred to as paralanguage. It is important
to understand this component of communication because it affects how the
verbal message is likely to be interpreted. When the tone of voice does not
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fit the words, the message is less easily understood and is less likely to be
believed. Pitch and tone can either support or contradict the content of the
verbal message. Sense of confidence will be reflected in tone of voice. Verbal
message is affected by voice inflection.
DIF: Cognitive Level: Application REF: p. 101
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
6. Communication is a combination of
a.
b.
c.
d.
verbal and nonverbal behaviors.
pitch, tone, and paralanguage.
proxemics, touch, and kinesics.
eye contact, facial expressions,
and nonverbal messages.
ANS: A
Communication is a combination of verbal and nonverbal behaviors
integrated for the purpose of sharing information. Pitch, tone, and
paralanguage are all components of vocalization. Proxemics, touch, and
kinesics are all nonverbal components. Eye contact and facial expressions
are nonverbal communication.
DIF: Cognitive Level: Knowledge REF: p. 100
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
7. The majority of person-to-person communication is
a.
verbal.
b.
process.
c.
nonverbal.
d.
content.
ANS: C
The majority of person-to-person communication is nonverbal. Actions speak
louder than words. Process refers to interpersonal sensitivity. Content refers
to giving information.
DIF: Cognitive Level: Knowledge REF: p. 102
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
8. When the nurse asks a client, “How are you?” the client states, “I am fine.”
As the client turns away, she is crying. This is an example of
a.
nonverbal communication.
b.
incongruence.
c.
proxemics.
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congruence.
d.
ANS: B
When nonverbal and verbal cues do not match, it is known as incongruence.
This situation includes both verbal and nonverbal content. Proxemics refers
to personal space. Congruence occurs when verbal and nonverbal messages
match.
DIF: Cognitive Level: Application REF: p. 107
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
9. An adult client responds to questions inappropriately. The nurse should do
which of the following?
a.
b.
c.
d.
Assume that the client is
depressed and seek further
information.
Ask other staff members whether
the client is sick.
Leave the client alone for now
and return to reassess.
Observe the client’s nonverbal
behavior.
ANS: D
When nonverbal cues are incongruent with the verbal information, messages
are likely to be misinterpreted. When the verbal message is inconsistent with
the nonverbal expression of the message, the nonverbal expressions assume
prominence and are generally perceived as more trustworthy than the verbal
content.
DIF: Cognitive Level: Application REF: p. 102
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
10. The nurse is assessing a newly admitted Native American client. When
assessing the client’s perception of touch, the nurse should
a.
casually touch the client.
b.
use timing with touch.
c.
ask the client for permission to
touch.
d.
shake the client’s hand.
ANS: C
Care must be taken to abide by the client’s cultural proscriptions about the
use of touch. This varies across cultures. Some Native Americans use touch in
healing, so that casual touching may be taboo. The nurse should ask for
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permission before the use of touch.
DIF: Cognitive Level: Application REF: p. 103
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
11. When communicating with a client, which of the following best demonstrates
the use of nonverbal communication?
a.
Ignoring nonverbal cues
b.
Holding the client’s hand
c.
Conversing with the client
d.
Using incongruent nonverbal
behaviors
ANS: B
Skilled use of nonverbal communication through [therapeutic] silences, use
of congruent nonverbal behaviors, body language, touch, proximics, and
attention to client nonverbal cues such as facial expression can improve the
relationship and build rapport with a client. Conversing with the client is an
example of verbal communication.
DIF: Cognitive Level: Application REF: p. 103
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
12. A client states he is feeling fine, but the nurse observes that he has a tense
body posture and a frown on his face. The nurse suspects that he is
experiencing pain based on knowledge of
a.
confirming responses.
b.
denotation.
c.
proxemics.
d.
kinesics.
ANS: D
Kinesics is an important component of nonverbal communication. Commonly
referred to as body language, it is defined as involving the conscious or
unconscious body positioning or actions of the communicator. Words direct
the content of a message, whereas emotions accentuate and clarify the
meaning of the words. Confirming responses are responses used by the
nurse. Denotation refers to generalized meaning of words. Proxemics refers
to personal space.
DIF: Cognitive Level: Application REF: p. 103
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
13. In relation to gender differences in communication, which of the following is
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true?
a.
b.
c.
d.
Men use more verbal
communication in interpersonal
relationships.
Women smile more often.
Men require less personal space
than women.
Men have a greater range of
vocal pitch.
ANS: B
Studies show that women tend to use more facial expressiveness, smile
more often, maintain eye contact, touch more often, and nod more often.
Men use less verbal communication than women in interpersonal
relationships. Studies show that men prefer a greater interpersonal distance
between themselves and others and that they use gestures more often.
Women have a greater range of vocal pitch and also tend to use different
informal patterns of vocalization than men. They use more tones signifying
surprise, cheerfulness, and unexpectedness.
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: All phases
p. 106
MSC: Client Needs: Psychosocial Integrity
14. Social cognitive competency refers to
a.
the ability to use verbal and
b.
c.
d.
nonverbal interventions.
understanding the relationships
between the roles of the sender
and receiver.
the ability to interpret message
content within interactions from
the point of view of each
participant.
interpreting emotional content by
observing body language.
ANS: C
Social cognitive competency is the ability to interpret message content
within interactions from the point of view of each of the participants. The
ability to use verbal and nonverbal interventions refers to message
competency. Understanding relationships of the sender and receiver refers
to role relationship. Interpreting emotional content by observing body
language refers to body cues.
DIF: Cognitive Level: Knowledge REF: p. 109
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Psychosocial Integrity
15. Which of the following messages would validate the worth of the individual?
a.
The nurse says, “Take that tray to
room 6 bed 2.”
“I want to know about your
physical symptoms following the
chemotherapy.”
“Now dear, we are going to have
a nice bath.”
“I would like to meet your family
and we could talk to them about
your aftercare.”
b.
c.
d.
ANS: D
Styles that convey “caring” send a message of individual worth that sustains
the relationship with the client. For example, clients prefer that providers use
a “warm” communication style to show caring, give information, and to allow
them time to talk about their own feelings. Confirming responses validate the
intrinsic worth of the person. These are responses that affirm the right of the
individual to be treated with respect. They also affirm the client’s autonomy
(i.e., his or her right, ultimately, to make his or her own decisions). Giving
directives is a disconfirming message. Discussing physical symptoms is a
behavior that decreases involvement with client’s emotional self. “Now dear,
we are going to have a nice bath” depersonalizes the client.
DIF: Cognitive Level: Application REF: p. 102
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
16. A communication style the nurse can use to ensure that the message sent is
the same as the one received is to
a.
b.
c.
d.
refer to the client by diagnosis.
establish a common vocabulary.
have interactions that focus on
physical care.
refer to the client by bed number.
ANS: B
For successful communication, words used should have a similar meaning to
both individuals in the interaction. An important part of the communication
process is the search for a common vocabulary so that the message sent is
the same as the one received. Referring to the client by diagnosis, having
interactions focus on physical care, and referring to the client by bed number
are communication styles that do not ensure that the message sent is the
same as the one received.
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DIF: Cognitive Level: Knowledge REF: p. 109
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
17. Message competency refers to which phase of the nursing process?
a.
Assessment
b.
Planning
c.
Intervention
d.
Evaluation
ANS: C
Message competency refers to the ability to use language and nonverbal
behaviors strategically in the intervention phase of the nursing process to
achieve the goals of the interaction. The assessment, planning, and
evaluation phases of the nursing process are incorrect answers.
DIF: Cognitive Level: Knowledge REF: p. 109
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which of the following is true in relation to the context of the message?
(Select all that apply.)
a.
b.
c.
d.
e.
It is shaped by the situation in
which the interaction occurs.
Taking time to evaluate the time
and space in which the contact
takes place allows for flexibility in
choosing the appropriate context.
Communication is shaped by the
environment in which it takes
place.
Evaluating the physical setting in
which the contact takes place
allows for flexibility in choosing
the appropriate context.
The environment has little effect
on communication.
ANS: A, B, C, D
Communication is always influenced by the environment in which it takes
place. It does not occur in a vacuum but is shaped by the situation in which
the interaction occurs. Taking time to evaluate the physical setting and the
time and space in which the contact takes place, as well as the
psychological, social, and cultural characteristics of each individual involved,
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gives the nurse flexibility in choosing the most appropriate context. The
environment always influences communication.
DIF: Cognitive Level: Knowledge REF: p. 110
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
Chapter 7: Intercultural Communication
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Cultural competence
a. involves a lack of acceptance of cultural differences in others.
b. requires self-awareness of one’s own cultural values.
c. is a nonessential skill set required for health care providers.
d. begins with developing knowledge and acceptance of cultural differences in others.
ANS: B
Cultural competence is defined as “a set of cultural behaviors and attitudes integrated into the
practice methods of a system, agency, or its professionals that enables them to work effectively
in cross-cultural situations.” Cultural competence is an essential skill set required for health care
providers. Self-awareness of unintentional bias in health care is essential. Value judgments are
hard to eliminate, particularly those outside of awareness. Developing competence begins with
self-awareness of one’s own cultural values, attitudes, and perspectives, followed by developing
knowledge and acceptance of cultural differences in others.
DIF: Cognitive Level: Knowledge
REF: p. 117
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. Which of the following best describes cultural diversity?
a. Encompasses variations between cultural groups
b. A smaller group of people living within the dominant culture who have adopted a
cultural lifestyle distinct from that of the mainstream population
c. Groups in which members share a cultural heritage from one generation to another
d. Heterogeneous society in which diverse cultural worldviews can coexist
ANS: A
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Cultural diversity refers to variations among cultural groups. People notice differences related to
language, mannerisms, and behaviors in people of different cultures, in ways that don’t happen
with people from their own culture. Subculture refers to a smaller group of people living within
the dominant culture, who have adopted a cultural lifestyle distinct from that of the mainstream
population. Ethnicity is used to describe “groups in which members share a cultural heritage
from one generation to another.” Personal awareness of a common racial, geographic, religious,
or history binds people together, with a strong commitment to ethnic values and practices.
Multiculturalism describes a heterogeneous society in which diverse cultural worldviews can
coexist with some general characteristics shared by all cultural groups and some perspectives
that are unique to a particular population.
DIF: Cognitive Level: Knowledge
REF: p. 114
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. When communicating with a client from Thailand who speaks limited English, the nurse should
a. use technical jargon and complex sentences.
b. recognize nodding as an indicator the client agrees with what the nurse is saying.
c. speak quickly and concisely, using complex words.
d. provide advice in a matter-of-fact, concise manner.
ANS: D
People tend to think and process information in their native language, translating back and forth
from English. This results in delayed responses that need to be taken into account, particularly in
health teaching. Sometimes the nurse is aware only that the client seems to be taking more time
than usual. All written information should be provided in the person’s native language whenever
possible to avoid misinterpretation. It is important that the translator of information be as wellversed in medical interpretations as in relevant terms used in both languages. With clients
demonstrating limited English proficiency, the nurse should speak slowly and clearly; use simple
words; and avoid slang, technical jargon, and complex sentences. Asian clients prefer a polite,
friendly, but formal approach in communication. They appreciate clinicians willing to provide
advice in a matter-of-fact, concise manner. Confrontation is avoided; clients will nod and smile
in agreement, even when they strongly disagree.
DIF: Cognitive Level: Application
REF: p. 130
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
4. When practicing cultural awareness, the nurse recognizes that cultural patterns
a. are socially transmitted through ethnic groups.
b. are nonessential parts of personal identity.
c. are minor determinants of health-related attitudes.
d. are important determinants of health-related beliefs.
ANS: D
Cultural patterns are socially transmitted through family and other social institutions. They are an
essential part of personal identity. Cultural patterns are important determinants of health-related
beliefs, attitudes, values, and behaviors.
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DIF: Cognitive Level: Analysis
REF: p. 113
TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Management of Care
5. The nurse is performing an admission assessment on an Asian client. The intake includes a
cultural assessment. The nurse should ask the client,
a. “Does a minister, priest, or rabbi visit you?”
b. “Do you feel understood and loved?”
c. “What language do you prefer to speak?”
d. “Does life have meaning and value for you?”
ANS: C
A cultural assessment is defined as a systematic appraisal of beliefs, values, and practices
conducted to determine the context of client needs and to tailor nursing interventions. It is
composed of three progressive, interconnecting elements: (1) a general assessment; (2) a
problem-specific assessment; and (3) the cultural details needed for successful implementation.
Asking about visits from a spiritual leader would be part of the spiritual assessment. Feelings and
value of life do not assess cultural issues.
DIF: Cognitive Level: Application
REF: p. 122
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Management of Care
6. The nurse is caring for a Hispanic client. When communicating with the client’s family about the
client’s illness, which family member should the nurse contact?
a. Oldest female family member
b. Oldest male family member
c. Oldest daughter of client
d. Oldest son of client
ANS: B
Hispanics are an extroverted people who value interpersonal relationships. Hispanic clients trust
feelings more than facts. Strict rules govern social relationships (respecto), with higher status
being given to older individuals, and to male over female individuals. Nurses are viewed as
authority figures, to be treated with respect. Clients hesitate to ask questions, so it is important to
ask enough questions to ensure that clients understand their diagnosis and treatment plan.
DIF: Cognitive Level: Application
REF: p. 125
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
7. A nursing instructor is teaching a group of student nurses about culture. When teaching the
students nurses about the concept of ethnocentrism, the student nurses demonstrate cultural
sensitivity when they state that their culture
a. is superior to others.
b. has the right to impose its standards of “correct” behavior and values on another.
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c. is a culture that warrants a sense of pride.
d. should be the norm because it is considered better or more enlightened than others.
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ANS: C
Ethnocentrism refers to a belief that one's own culture should be the norm because it is
considered better or more enlightened than others. Other cultures are judged as inferior. Taking
pride in one's culture is appropriate, but when a person fails to respect the value of other cultures,
it is easy to develop stereotypes and prejudice. Ethnocentrism fosters the belief that one culture
has the right to impose its standards of “correct” behavior and values on another. Prejudice can
be felt or expressed, and directed to either a group as a whole or toward an individual associated
with the group.
DIF: Cognitive Level: Analysis
REF: p. 116
TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Management of Care
8. When caring for a client from a different culture, which of the following is the best assessment
approach by the nurse?
a. “Are there any special cultural beliefs about your illness that might help me give
you better care?”
b. “Describe to me your position of greatest relief from pain and discomfort.”
c. “I will return shortly to give you a pain medication. Is there anything else that you
need?”
d. “I will roll your bed down and place a pillow between your legs.”
ANS: A
When assessing client preferences in a client from a different culture, an assessment approach
can include asking about special cultural beliefs related to the illness that might help the nurse to
provide better care. Questions regarding a client’s level of physical comfort do not address the
client’s culture.
DIF: Cognitive Level: Application
REF: p. 121
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
9. The nurse is assigned to provide a bed bath to a client who cannot speak English. Which of the
following communication tools or strategies should the nurse use?
a. Nonverbal communication
b. Trained interpreter
c. Family member as interpreter
d. Other staff member who speaks the same language
ANS: B
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Federal law (Title VI of the Civil Rights Act) mandates the use of a trained interpreter for any
client experiencing communication difficulties in health care settings because of language.
Interpreters should have a thorough knowledge of the culture, as well as the language.
Interpreters should be carefully chosen, keeping in mind variations in dialects as well as
differences in the sex and social status of the interpreter and the client if these factors are likely
to be an issue. There are quality assurance and ethical issues associated with the use of untrained
interpreters such as family, friends, or ancillary staff. They may not be familiar with medical
terminology or may unintentionally misrepresent the meaning of a message. The client may or
may not want a relative, friend, or nonprofessional staff to “know their business” or have access
to subjective information.
DIF: Cognitive Level: Application
REF: p. 122
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Management of Care
10. The nurse is caring for a postpartum client who is African American. The nurse recognizes that
an essential component for successful communication when interacting with this client is the use
of
a. clergy in treatment plans.
b. only simple language strategies.
c. folk-healing strategies.
d. trust development.
ANS: D
Although African Americans are represented in every socioeconomic group, approximately one
third of them live in poverty. For many, their cultural heritage traces back to slavery and
deprivation. This unfortunate legacy colors the expectations of African Americans with health
care issues and explains the distrust many African Americans have about the American health
care system. African Americans need to experience feeling respected by their caregivers to
counteract the sense of powerlessness they feel in health care settings. Establishing trust is
essential for successful communication with African American clients. They are more willing to
participate in treatment when they feel respected and are treated as treatment partners in their
health care. Trust must be established before any interventions, such as consultation with a folk
healer or clergy. There is no language barrier mentioned in the question.
DIF: Cognitive Level: Application
REF: p. 126
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
11. Which of the following statements is true?
a. A Muslim client may refuse to take insulin if it contains beef.
b. African American males have a lower chance of developing cancer.
c. Hispanic clients make small talk before discussing their health problems.
d. Asian clients frequently challenge health care workers.
ANS: C
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Hispanic clients need to develop trust (confianza) in the health care provider. They do this by
making small talk before getting down to the business of discussing their health problems.
Muslim clients are expected to follow the Hallal (lawful) diet, which calls for dietary restrictions
on eating pork or pork products, and drinking alcohol. African American males have a
significantly greater chance of developing cancer and of dying from it. Communication
behaviors in the Asian culture are characterized by mutuality, respect, and honesty. Health care
providers are considered health experts, so they are expected to provide specific advice and
recommendations. Asian clients prefer a polite, friendly, but formal approach in communication.
They appreciate clinicians willing to provide advice in a matter-of-fact, concise manner.
DIF: Cognitive Level: Comprehension
REF: p. 126
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
12. When assessing a 5-year-old Asian client in the emergency department, the nurse observes welts
on the client’s body. The nurse’s first course of action should be to
a. report child abuse to the authorities.
b. consult a traditional healer.
c. question the family about cultural practices.
d. ignore it because it is an imbalance between “yin and yang.”
ANS: C
In some Asian countries, healers use a process of “coining,” in which a coin is heated and
vigorously rubbed on the body to draw illness out of the body. The resulting welts can
mistakenly be attributed to child abuse if this practice is not understood. A cultural assessment
needs to be done first. The first course of action is to do a cultural assessment by questioning the
family. The welts should not be ignored because they could indicate child abuse.
DIF: Cognitive Level: Analysis
REF: p. 129
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Management of Care
13. When performing a newborn bath demonstration for the mother of a Native American infant, the
nurse should
a. maintain constant eye contact with the mother.
b. anticipate answering many of the mother’s questions.
c. ask the mother to stand next to the nurse.
d. deliver verbal instructions in a story-telling format.
ANS: D
When the nurse is performing a newborn bath demonstration, the Native American mother is
likely to watch from a distance, avoid eye contact with the demonstrator, ask few or no
questions, and decline a return demonstration. This learning style should not be seen as
indifference or lack of understanding. Being an experiential learner, the Native American woman
is likely to assimilate the information provided and simply give the newborn a bath when it is
needed. Their learning style is observational and oral, so the use of charts, written instructions,
and pamphlets is usually not well received. Verbal instruction delivered in a story-telling format
is more familiar to Native Americans.
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DIF: Cognitive Level: Application
REF: p. 131
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Management of Care
14. Which of the following is a true statement in relation to the concept of poverty?
a. Poverty affects only a small segment of the population.
b. Poor people expect others to work with them in making things better.
c. Communication strategies that empower the poor to take small steps toward
dependence are most effective.
d. Lack of essential resources is associated with political and personal powerlessness.
ANS: D
Poverty is a difficult but important sociocultural concept because it has an adverse effect on a
large segment of the population, limiting their options in health care. Lack of essential resources
is associated with political and personal powerlessness. The idea that the poor can exercise
choice or make a difference in their lives is not part of their worldview. People living in poverty
may overlook opportunities simply because life experience tells them that they cannot trust their
own efforts to produce change. Poor people often look to others, but do not expect others to work
with them in making things better. Communication strategies that acknowledge, support, and
empower the poor to take small steps to independence are most effective.
DIF: Cognitive Level: Knowledge
REF: p. 131
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
15. When caring for the poor client, a major component of care is
a. ignoring personal biases.
b. allowing stereotypes to distort nursing interventions.
c. maintaining respect for human dignity.
d. treating all clients exactly the same.
ANS: C
Respect for the human dignity of the poor client is a major component of proactive care. This
means that the nurse pays strict attention to personal biases and stereotypes so as not to distort
assessment or implementation of nursing interventions. It means treating each client as
“culturally unique,” with a set of assumptions and values regarding the disease process and its
treatment, and acting in a nonjudgmental manner that respects the client’s cultural integrity.
DIF: Cognitive Level: Knowledge
REF: p. 132
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
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Chapter 8: Therapeutic Communication in Groups
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following is a characteristic of a secondary group?
a. There is not a designated leader.
b. They have a prescribed structure.
c. They lack identified specific goals.
d. The group remains together even when goals are achieved.
ANS: B
Secondary groups differ from primary groups in purpose and function because they have a
prescribed structure; a designated leader; and specific goals. When the group completes its task
or achieves its goals, the group disbands.
DIF: Cognitive Level: Knowledge
REF: p. 136
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. The nurse is caring for a client who has a large extended family. The nurse recognizes the client
is part of a group known as a
a. focus group.
b. educational group.
c. primary group.
d. secondary group.
ANS: C
A group is a social unit that can satisfy a person’s need for belongingness. Groups are
categorized as primary or secondary. Primary groups are formed early in life and are
characterized by an informal structure and close personal relationships. Primary groups have a
lifelong influence on self-identity and social behaviors. Group membership is automatic (e.g., in
a family) or voluntarily chosen because of a common interest (e.g., long term friendship) and is
open ended. Secondary groups are described as purposeful, planned, time-limited relationships
with an established beginning and end. Secondary groups differ from primary groups in purpose
and function because they have a prescribed structure; a designated leader; and specific goals.
When the group completes its task or achieves its goals, the group disbands. People join
secondary groups to meet personally established goals, to develop knowledge and skills, or
because it is required by the larger community system to which the individual belongs. Work
groups, social action, and health-related therapeutic or support groups are good examples.
DIF: Cognitive Level: Comprehension
REF: p. 136
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Psychosocial Integrity
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3. Which of the following describes group think?
a. A member of a corporate executive committee states, “You could be making a big
mistake.”
b. Members of a corporate executive committee fail to inform the chairperson that
some middle managers do not support the decision.
c. A corporate executive committee cancels a press conference in light of poor market
survey results.
d. Members demonstrate a willingness to take interpersonal risks
ANS: B
Extreme cohesiveness can result in a negative group phenomenon referred to as group think.
Group think occurs when the approval of other group members becomes so important that group
members support a decision they fundamentally don’t agree with, just for the sake of harmony.
Individual members are afraid to express conflicting ideas and opinions for fear of being
excluded from the group. The group exerts pressure on members to act as one voice in decision
making. Realistic evaluation of issues doesn’t occur because group members minimize conflict
in an effort to reach consensus.
DIF: Cognitive Level: Analysis
REF: pp. 154-155
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
4. Which of the following statements is true in relation to task functions?
a. When task functions predominate, member satisfaction increases.
b. When maintenance functions predominate, goals are achieved.
c. They are behaviors used to move toward goal achievement.
d. They are behaviors designed to ensure personal satisfaction.
ANS: C
Functional roles differ from positional roles group members assume in that they are related to the
type of member contributions needed to achieve group goals. Constructive role functions are the
behaviors members use to move toward goal achievement (task functions) and behaviors
designed to ensure personal satisfaction (maintenance functions). When task functions
predominate, member satisfaction decreases. When maintenance functions override task
functions, members have trouble reaching goals.
DIF: Cognitive Level: Knowledge
REF: p. 142
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. When leading a group meeting, the nurse notices two group members talking. Which of the
following represents the best intervention by the nurse?
a. Ask the group, “Have you noticed who is talking at this time?”
b. Tell the two group members, “I would like you to stop talking.”
c. Provide the two group members with a verbal summary of what the group has been
discussing.
d. Ask the two group members, “Would you share your comments with the group?”
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ANS: D
Self-roles are roles a person uses to meet self-needs at the expense of other members’ needs,
group values, and goal achievement. Self-roles detract from the group’s work and compromise
goal achievement by taking time away from group issues and creating discomfort among group
members. Challenging the talkers does not foster a safe environment in which to express
feelings. With group communication strategies, the desired communication flow is from member
to member, rather than from nurse leader to client.
DIF: Cognitive Level: Application
REF: p. 142
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
6. The group leader states, “Today we discussed some of the issues about taking medications, and
each one of you developed a goal in relation to some of the problems you were experiencing. I
think it was helpful that some of you were able to share your experiences with other group
members.” The leader is using the technique of
a. harmonizing.
b. summarizing.
c. encouraging.
d. compromising.
ANS: B
Summarizing pulls related ideas together; restates key ideas; offers a group solution or
suggestion for other members to accept or reject. Harmonizing attempts to reconcile
disagreements; helps members reduce conflict and explore differences in a constructive manner.
Encouraging indicates by words and body language unconditional acceptance of others; agrees
with contributions of other group members; and is warm, friendly, and responsive to other group
members. Compromising admits mistakes; offers a concession when appropriate; and modifies
position in the interest of group cohesion.
DIF: Cognitive Level: Application
REF: p. 142
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
7. The nurse notices that a group member is quiet during support group meetings. What is the best
intervention by the nurse for involving the quiet group member in the group process?
a. Ask the group if they have noticed that a group member never talks.
b. Ask the group what can be done to involve the quiet group member more.
c. Set up a private meeting with the quiet group member to discuss group
participation.
d. Ask the quiet group member if he or she would like to comment on what another
group member has just said.
ANS: D
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Group participation on an equal basis should be a group expectation. Although the level of
participation is never quite equal, discussion groups in which only a few members actively
participate are disheartening to group members and limited in learning potential. Because the
primary purpose of a discussion group is to promote the learning of all group members, other
members are charged with the responsibility of encouraging the participation of more silent
members. Sometimes, when more verbal participants keep quiet, the more reticent group
member begins to speak.
DIF: Cognitive Level: Application
REF: p. 151
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
8. A breast cancer support group is an example of a
a. closed group.
b. private group.
c. homogeneous group.
d. heterogeneous group.
ANS: C
Homogeneous groups share common characteristics, for example, diagnosis (e.g., breast cancer
support group) or a personal attribute (e.g., gender or age). Closed groups have a predefined
selected membership with an expectation of regular attendance for an extended time period,
usually at least 12 sessions. Group members may be added, but their inclusion depends on a
match with group-defined criteria. Most psychotherapy groups fall into this category. A breast
cancer support group is not an example of a private group but is an example of an open group in
which individuals can come and go depending on their needs. Heterogeneous groups represent a
wider diversity of human experience and problems. Members vary in age, gender, and
psychodynamics. Most psychotherapy and insight-oriented personal growth groups have a
heterogeneous membership. Educational groups held on inpatient units (e.g., medication groups)
may have a homogeneous membership related to diagnosis or specific learning needs.
DIF: Cognitive Level: Knowledge
REF: p. 143
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Management of Care
9. During the first session of an Alzheimer disease support group for family members, the nurse
recognizes the need to
a. encourage member contributions and emphasize cooperation in recognizing each
person’s talents related to group goals.
b. accept differences in member perceptions as being normal and growth producing.
c. encourage group members to introduce themselves and share a little of their
background or their reason for coming to the group.
d. link constructive themes while stating the nature of the disagreement.
ANS: C
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The forming phase in therapeutic groups focuses on helping clients establish trust in the group
and with each other. Communication is tentative. Members are asked to introduce themselves
and share a little of their background or their reason for coming to the group. Once initial conflict
is resolved in the storming phase, the group moves into the norming phase. Group-specific norms
have developed from discussions in the previous phase. The leader encourages member
contributions and emphasizes cooperation in recognizing each person’s talents related to group
goals. The storming phase helps group members move to a deeper level. In the storming phase,
the gloves come off and communication can become controversial. The leader plays an important
facilitative role in the storming phase by accepting differences in member perceptions as being
normal and growth producing. By affirming genuine strengths in individual members, leaders
model handling conflict with productive outcomes. Linking constructive themes while stating the
nature of the disagreement is an effective modeling strategy.
DIF: Cognitive Level: Application
REF: p. 145
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
10. When members of a group experience controversy, conflict, and disagreements, the nurse leading
the group recognizes the importance of
a. encouraging member contributions and emphasizing cooperation in recognizing
each person’s talents related to group goals.
b. focusing on working together and participating in another person’s personal
growth.
c. having members introduce themselves and share a little of their background or
their reason for coming to the group.
d. accepting differences in member perceptions as being normal and growth
producing.
ANS: D
The storming phase helps group members move to a deeper level. In the storming phase, the
gloves come off and communication can become controversial. The leader plays an important
facilitative role in the storming phase by accepting differences in member perceptions as being
normal and growth producing. By affirming genuine strengths in individual members, leaders
model handling conflict with productive outcomes. Linking constructive themes while stating the
nature of the disagreement is an effective modeling strategy. Once initial conflict is resolved in
the storming phase, the group moves into the norming phase. Group-specific norms have
developed from discussions in the previous phase. The leader encourages member contributions
and emphasizes cooperation in recognizing each person’s talents related to group goals. In the
performing stage of group development, members focus on problem solving. Working together
and participating in another person’s personal growth allows members to experience one
another’s personal strengths and the collective caring of the group. The forming stage is an
orientation phase. Communication is tentative and structured to allow members to learn about
each other and develop trust. The leader takes an active role in helping group members feel
accepted during the forming stage. Members are asked to introduce themselves and share a little
of their background or their reason for coming to the group.
DIF: Cognitive Level: Analysis
REF: p. 146
TOP: Step of the Nursing Process: Implementation
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MSC: Client Needs: Psychosocial Integrity
11. A long-standing group therapy meeting has been in process for 1/2 hour when a member arrives
late. Another member says, “I thought we agreed as a group to come on time.” This statement
represents which of the following?
a. Regulation
b. Law
c. Role
d. Norm
ANS: D
Group norms refer to the unwritten behavioral rules of conduct expected of group members.
Norms provide needed predictability for effective group functioning and make the group safe for
its members. There are two types of group norms: (1) universal and (2) group specific. Universal
norms are stated behavioral standards, which must be present in all groups for effective
outcomes. Examples include confidentiality, regular attendance, and not socializing with
members outside of the group. Unless group members can trust that personal information will
not be shared outside the group setting (confidentiality), trust will not develop. Regular
attendance at group meetings is critical to group stability and goal achievement. Personal
relationships between group members outside of the group threaten the integrity of the group as
the therapeutic arena for the group’s work. Group-specific norms evolve from the group itself in
the storming phase. They represent the shared beliefs, values, and unspoken operational rules
governing group function. Examples include tolerance for latecomers, use of humor or
confrontation, and talking directly to other group members rather than about them. Regulation,
law, and role are not examples of behavioral standards set by the group.
DIF: Cognitive Level: Application
REF: p. 154
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
12. During a support group meeting, a group member makes several sexually provocative remarks
toward the group leader. The best response by the group leader is,
a. “What do you think your fellow group member is trying to tell us?”
b. “I want to discuss your sexually provocative remarks privately after this meeting.”
c. “Our group work is of the highest priority; please align your remarks with the
group purpose.”
d. “I don’t appreciate what you are saying, you are excused from the group.”
ANS: C
Members who test boundaries through sexually provocative, flattering, or insulting remarks
should have limits set promptly. The group leader should refer to the work of the group as being
of the highest priority and tactfully ask the person to align remarks with the group purpose.
Limits need to be set promptly within the group. The group member should not be excused at
this stage.
DIF: Cognitive Level: Application
REF: p. 146
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
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13. When a group leader encourages the group members to express their feelings about one another
with the stipulation that any concerns the group may have about an individual member or
suggestions for future growth should be stated in a constructive way and the group leader
summarizes goal achievement, the group has reached which phase of group development?
a. Formative phase
b. Engagement
c. Active intervention
d. Termination
ANS: D
The final phase of group development, termination or adjournment, ideally occurs when the
group members have achieved desired outcomes. This phase is about task completion and
disengagement. The leader encourages the group members to express their feelings about one
another with the stipulation that any concerns the group may have about an individual member or
suggestions for future growth should be stated in a constructive way. The leader closes the group
with a summary of goal achievement. By waiting until the group ends to share closing
comments, the leader has an opportunity to soften or clarify previous comments and to connect
cognitive and feeling elements that need to be addressed. Engagement occurs during the forming
stage, and active interventions occur during the performing stage.
DIF: Cognitive Level: Knowledge
REF: p. 147
TOP: Step of the Nursing Process: Evaluation
MSC: Client Needs: Psychosocial Integrity
14. A staff nurse is assigned to lead a community group meeting comprised mostly of psychotic
clients. When setting up this type of group meeting, the nurse recognizes that
a. refreshments should always be eliminated in order to keep the meeting room neat
and orderly.
b. acutely psychotic clients generally can participate in community group meetings
prior to being stabilized.
c. the group leader should take a passive role in order to avoid frightening the clients.
d. choosing a fellow staff member to help co-lead the group is recommended.
ANS: D
Staff nurses are sometimes called upon to lead or co-lead unit-based group psychotherapy on
inpatient units. Other times staff nurses participate in community group meetings comprised
mostly of psychotic clients. Although acutely psychotic clients usually cannot participate until
they are stabilized, community groups and small structured therapy groups can be useful. A
directive but flexible leadership approach is needed. Because the demands of leadership are so
intense with psychotic clients, co-leadership is recommended. Co-therapists can share the group
process interventions, model healthy behaviors, offset negative transference from group
members, and provide useful feedback to each other. An introductory format for support group
leaders includes potentially allowing time for informal networking through providing a 10minute break with or without refreshments in order to allow members to interact informally with
each other. If a group topic is not forthcoming from members, the leader can introduce a
relevant, concrete, problem-centered topic of potential interest to the group.
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DIF: Cognitive Level: Application
REF: p. 148
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
15. A member of a support group is concerned that the group has not been ending on time and that
some members have been pairing off to discuss group issues after the meetings. The concerned
group member expresses these concerns during a group meeting. This is an example of which
maintenance function?
a. Setting standards
b. Consensus taking
c. Seeking information
d. Initiating discussion
ANS: A
Setting standards calls for the group to reassess or confirm implicit and explicit group norms
when appropriate. Group norms refer to the behavioral rules of conduct expected of group
members. Norms provide needed predictability for effective group functioning and make the
group safe for its members. There are two types of group norms: (1) universal and (2) group
specific. Universal norms are stated behavioral standards, which must be present in all groups for
effective outcomes. Examples include confidentiality, regular attendance, and not socializing
with members outside of the group. Unless group members can trust that personal information
will not be shared outside the group setting (confidentiality), trust will not develop. Regular
attendance at group meetings is critical to group stability and goal achievement. Personal
relationships between group members outside of the group threaten the integrity of the group as
the therapeutic arena for the group’s work. Group-specific norms evolve from the group itself in
the storming phase. They represent the shared beliefs, values, and unspoken operational rules
governing group function. Examples include tolerance for latecomers, use of humor or
confrontation, and talking directly to other group members rather than about them. Maintenance
functions are behaviors that help the group maintain harmonious working relationships.
Consensus taking checks to see whether the group has reached a conclusion, and asks the group
to test a possible decision. Consensus taking is an example of a task function. Seeking
information or opinion involves requesting facts from other members, asking other members for
opinions, and seeking suggestions or ideas for task accomplishment. Seeking information is an
example of a task function. Initiating involves identifying tasks or goals, defining the group
problem, and suggesting relevant strategies for solving the problem. Initiating is an example of a
task function.
DIF: Cognitive Level: Application
REF: p. 142
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
16. A member of a support group frequently whispers to other members of the group and appears
indifferent and passive during group meetings. Which of the following nonfunctional self-roles is
represented in this situation?
a. Aggressor
b. Avoider
c. Blocker
d. Self-confessor
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ANS: B
An example of a nonfunctional self-role is the role of avoider, which is characterized by
whispering to others, daydreaming, doodling, and acting indifferent and passive. Another
example of a nonfunctional self-role is the role of aggressor, which is characterized by criticizing
or blaming others, personally attacking other members, and using sarcasm and hostility in
interactions. Another nonfunctional self-role is the role of blocker, which is characterized by
instantly rejecting ideas or arguing an idea to death, citing tangential ideas and opinions, and
obstructing decision making. A final example of a nonfunctional self-role is the role of selfconfessor, which is characterized by using the group to express personal views and feelings
unrelated to the group task.
DIF: Cognitive Level: Application
REF: p. 142
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
17. The nurse recognizes an effective group includes which of the following characteristics?
a. Power resides in the leader and is not shared.
b. Communication is guarded and feelings are not always given attention.
c. Goals are vague or imposed on the group without discussion.
d. Goals are clearly identified and collaboratively developed.
ANS: D
Characteristics of effective groups include having goals that are clearly identified and
collaboratively developed. Unshared leader power, guarded communication and feelings, and
vague goals are examples of ineffective group characteristics.
DIF: Cognitive Level: Application
REF: p. 152
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
Chapter 9: Self Concept in Professional Interpersonal Relationships
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following represents the role of the nurse in helping a client reframe a potentially
incapacitating sense of self into one with more hope and broader options when faced with a
health-related difficulty?
a. They can take a passive approach.
b. They can negate potential possibilities.
c. They can focus on personal weaknesses.
d. They can reframe the client’s sense of self.
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ANS: D
When life “throws a health-related curve ball,” nurses play a critical role in helping clients
reframe a potentially incapacitating sense of self into one with more hope and broader options.
They can help clients revisit personal strengths, consider new possibilities, incorporate new
information, and seek out appropriate resources as a basis for making good clinical decisions and
taking constructive actions. Even a nurse’s “supportive presence” can give a client a reason to
hope.
DIF: Cognitive Level: Comprehension
REF: p. 161
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. An older adult client is admitted to the hospital with terminal cancer. The client expresses
acceptance of impending death and states, “I am very satisfied with the life I had.” The nurse
recognizes the client is in Erikson’s stage of psychosocial development known as which of the
following?
a. Integrity vs. Despair
b. Autonomy vs. Shame and Doubt
c. Intimacy vs. Isolation
d. Identity vs. Identity Diffusion
ANS: A
In this stage, the focus is the meaning of life and worth. It includes acceptance of growing
limitations while maintaining a maximum productivity. Expression of acceptance of certitude of
death as well as satisfaction with one’s contributions to life are also characteristics of this stage.
Autonomy versus Shame and Doubt occurs during the toddler stage of development. Intimacy
versus Isolation occurs during the young adult stage. Identity versus Identity Diffusion occurs
during adolescence.
DIF: Cognitive Level: Application
REF: p. 164
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. The nurse is caring for an adolescent client who has had an amputation of his right leg. The client
states, “I’m really worried my girlfriend might not want to be with me anymore. I don’t look the
same.” Which of the following concepts is represented in this situation?
a. Role performance
b. Body image
c. Self-esteem
d. Personal identity
ANS: B
This situation refers to an individual’s perception of the body. The situation is not about how the
client performs but about how he perceives his body. Self-esteem refers to the significance
placed on self-concept. Personal identity concept refers to perceptual, cognitive, emotional, and
spiritual elements.
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DIF:
Cognitive Level: Application
REF: pp. 166-167
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TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
4. Which of the following statements about perception is true?
a. Perception is a function of the senses.
b. Perception is an interpersonal process.
c. Positive images are retained longer than negative ones.
d. Personal identity is constructed through cognitive processes of perception.
ANS: D
Personal identity is constructed through cognitive processes of perception and cognition.
Perception is a function of the mind, not the senses. Perception is an intrapersonal process.
Negative images are retained longer than positive ones.
DIF: Cognitive Level: Comprehension
REF: p. 178
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. Identify the type of perceptual alteration represented in the following example: Jim, a 12-year-
old, states, “I am different from others in my physical education class because I am the class
dunce.”
a. Distorted reality
b. Selective attention
c. Self-fulfilling prophecy
d. Cognitive distortion
ANS: C
Negative concepts of possible selves can become a self-fulfilling prophecy. Distorted reality
refers to a sense of self not based in reality. Selective attention occurs when a person hears only
part of the message. Cognitive distortion refers to a distortion in thinking.
DIF: Cognitive Level: Application
REF: p. 160
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
6. A client states, “I am an obese, compulsive person.” The nurse demonstrates how to conduct a
perceptual check when stating which of the following?
a. “Can you tell me more about this?”
b. “Is it difficult for you to be this way?”
c. “I wouldn’t worry about being very neat.”
d. “It is okay to be this way; you are not hurting anyone.”
ANS: A
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Frequent perceptual checks and active listening are helpful interventions. When combined with
well–thought-out inferences about the meaning of client behaviors, they enhance the quality of
decision making in the nurse-client relationship. Checking in with clients allows the nurse to use
perceptual data in a conscious, deliberate way to facilitate the relationship process. “Is it difficult
for you to be this way?” allows for only a “yes” or “no” answer and does not actively engage the
client in conversation. “I wouldn’t worry about being very neat” does not encourage an active
conversation. “It is okay to be this way; you are not hurting anyone” does not encourage an
active conversation.
DIF: Cognitive Level: Analysis
REF: p. 169
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
7. When learning about the Johari Window, the student nurse recognizes that the model consists of
four areas, and that the hidden self can best be described as
a. what is known to self and others.
b. what is known by others, but not by self.
c. what is known by self, but not by others.
d. what is unknown to self and also unknown to others.
ANS: C
Although cognitive awareness of the self-concept is never fully complete, the Johari Window
provides a disclosure/feedback model to help people learn more about their self-concept (Luft &
Ingham). The model consists of four areas:
• Open self (arena): what is known to self and others
• Blind self: what is known by others, but not by self
• Hidden self (façade): what is known by self, but not by others
• Unknown self: what is unknown to self and also unknown to others
DIF: Cognitive Level: Application
REF: p. 162
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
8. When giving a class presentation on self-concept, a student nurse notices that a classmate has
fallen asleep. The student nurse immediately decides that the presentation must be boring and
that she will fail this assignment and subsequently obtain a poor grade in the course. This is an
example of
a. selective attention.
b. negative self-talk.
c. self-fulfilling prophecy.
d. negative feedback.
ANS: B
Self-talk is a cognitive process people can use to lessen cognitive distortions. When the thought
carries a negative value, it can affect the individual as though the thought represented the whole
truth about the person. Selective attention occurs when a person hears only parts of a message. In
this situation, it could become a self-fulfilling prophecy if her performance does in fact suffer.
Negative feedback could occur if the instructor told the student the presentation was boring.
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DIF:
Cognitive Level: Application
REF: p. 170
TOP: Step of the Nursing Process: All Phases of the Nursing ProcessMSC:
Client Needs: Psychosocial Integrity
9. Which of the following statements is true about self-esteem?
a. It is an objective emotional process.
b. Achievements lead to high self-esteem.
c. It is the emotional value a person places on his or her self-concept.
d. It is a concept that becomes fixed.
ANS: C
Self-esteem is defined as the emotional value a person places on his or her self-concept. It
identifies the degree to which people approve of themselves.
DIF: Cognitive Level: Comprehension
REF: p. 170
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
10. When directing the behavior of clients, it is important for the nurse to
a. understand the dimensions of self-concept.
b. become personally involved with each client.
c. learn to control one’s feelings.
d. offer limited guidance and support.
ANS: A
Understanding the dimensions of self-concept and the critical role it plays in directing behavior
is key to working effectively with clients and families. It is always a core variable to consider in
nurse-client relationships. Nurses play an important role in providing support and guidance for
clients related to self-concept. The nurse engages with the client in a goal-directed professional
relationship. The nurse connects emotionally with the client.
DIF: Cognitive Level: Knowledge
REF: p. 178
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
11. To adequately meet the spiritual needs of clients, the nurse should first
a. learn to be considerate and sensitive.
b. distinguish between his or her own spiritual needs and those of the client.
c. meet the client’s spiritual needs.
d. offer to pray and read the bible with the client.
ANS: B
Nurses need to distinguish between their own spiritual orientation and needs and those of their
clients. It is not appropriate to impose a spiritual ritual on a client that would be at odds with his
or her spiritual beliefs. There should be some evidence from the client’s conversation that
praying or reading the bible with a client would be an acceptable support.
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DIF:
Cognitive Level: Application
REF: p. 177
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TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
12. A client has just had his status changed to “comfort care only.” The nurse recognizes that the
client is spiritually distressed. The nurse understands that spiritual pain
a. cannot be inferred from the client’s behavior.
b. is not as severe as physical pain.
c. cannot be verbally shared.
d. can be as severe as physical pain.
ANS: D
Spiritual pain can be as severe as physical pain and often is closely accompanied by emotional
pain. Asking about the effect an illness or health problem has had on spiritual beliefs yields
useful information. Being able to talk freely about spiritual distress helps put it into perspective.
Identifying a client’s current religious affiliations and practices is important, and inquiring about
religious rituals important to the client is essential. Spiritual pain can be inferred from behavior
and if the client is willing to share verbally.
DIF: Cognitive Level: Application
REF: pp. 175-176
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
13. The nurse is caring for a client who is anxious about a new diagnosis of cancer. When discussing
chemotherapy with the client, the nurse understands that
a. the client will need to be given instructions only once.
b. the client may only hear part of the instructions.
c. emotions obey the rules of logic.
d. a cognitive lack of understanding may occur.
ANS: B
The nurse should avoid sensory overload, and repeat instructions if the client appears anxious.
DIF: Cognitive Level: Application
REF: p. 169
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
14. After receiving her morning assignment, the nurse realizes that she will be caring for a client
with Alzheimer disease. The nurse understands that when communicating with this client, it will
be important to
a. avoid touch because this may be misinterpreted by the client.
b. shorten processing time before the client becomes distracted.
c. break instructions down into small, sequential steps.
d. present ideas all at once before the client’s attention wanders.
ANS: C
Keeping communication simple can help the client compensate for cognitive deficits. Use of
touch to emphasize directions or guide the client can help compensate for cognitive deficits.
Clients with cognitive deficits need more time to process information. Present ideas one at a
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DIF: Cognitive Level: Application
REF: p. 173
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
Chapter 10: Developing Therapeutic Relationships
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following examples indicates adherence to client confidentiality?
a. Talking about the client’s symptoms in front of family members
b. Using the client’s name in a social conversation
c. Sharing client information with other members of the health care team as needed
d. Reading a friend’s chart on another hospital unit
ANS: C
The nurse should assure the client that personal information will be treated as confidential and
explain that data will be shared with other members of the health care team as needed for making
relevant clinical decisions and informing the client about the general composition of the health
care team.
DIF: Cognitive Level: Comprehension
REF: p. 183
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. When your are administering medications to a client with human immunodeficiency virus (HIV),
the client states, “I should just stop taking them and get it over with.” A therapeutic response by
the nurse would be
a. “You have to take these! If you stop you will get very sick.”
b. “You’re just feeling depressed right now. You’ll feel better later.”
c. “ Tell me more about what you’re feeling.”
d. “You have the right to refuse treatment.”
ANS: C
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Therapeutic relationships should directly revolve around the client’s needs and each person’s
individualized expression of them. Using questions that follow a logical sequence and asking
only one question at a time are practices that help clients feel more comfortable and are likely to
elicit more complete data. Dealing with the client’s feelings with a statement such as, “Tell me
more about…” keeps the conversation flowing. The client has the right to choose a course of
action, even when it is at odds with the nurse’s ideas. The nurse stating how the client is feeling
is an assumption by the nurse about what the client is feeling. Although the client has the right to
refuse treatment, he is not really saying that he will refuse. The nurse needs to obtain more
information.
DIF: Cognitive Level: Application
REF: p. 190
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. A client has been informed by her physician that she requires emergency surgery. The client tells
the nurse, “I will have the surgery after I attend my family vacation.” Which of the following is
the most appropriate mutual goal for the client?
a. The client will accept the recommended medical regimen.
b. The client will alternate activity with rest throughout the day.
c. The client will take a leave of absence from her work schedule.
d. The client will check her blood pressure four times a day.
ANS: B
Nurse-client relationships are designed to empower clients and families to assume as much
responsibility as possible in self-management of chronic illness. Both nurse and client have
responsibilities and work toward agreed-upon goals. Shared knowledge, mutual decision-making
power, and respect for the capacities of client to actively contribute to his or her health care to
whatever extent is possible are active components. The client always has the right to choose the
course of action, even if it does not coincide with medical advice. If the client takes a leave of
absence from her work schedule, it is not a mutual goal. Setting the goal of having the client
check her blood pressure four times a day does not address the issue from the client perspective.
DIF: Cognitive Level: Application
REF: p. 183
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
4. A nurse whose father was an alcoholic is assigned to care for a client who is in alcohol
withdrawal. The nurse’s best therapeutic action would be to
a. request another assignment.
b. deliver care in short intervals to avoid projecting negativity.
c. examine personal vulnerabilities, strengths, and limitations.
d. monitor the client’s physical status closely.
ANS: C
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Authenticity is a precondition for the therapeutic use of self in the nurse-client relationship.
Authenticity requires recognizing personal vulnerabilities, strengths, and limitations; working
within this knowledge in the service of the client; and seeking help when needed to further
relationship goals. Self-awareness allows the nurse to fully engage with a client, knowing that
parts of the relationship may be painful, distasteful, or uncomfortable. Eventually the nurse will
have to deal with the issue. Shortening care time would not be therapeutic. The nurse needs to be
emotionally available to the client to be therapeutic.
DIF: Cognitive Level: Application
REF: p. 186
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. A nurse returns to work to find that a substitute nurse has changed the treatment plan of her
favorite client. In the presence of the client, the nurse becomes angry and critical of the other
nurse. This is an example of
a. overinvolvement.
b. client-centered approach.
c. professional focus.
d. disengagement.
ANS: A
Boundaries represent a continuum, with issues related to boundaries ranging from a lack of
involvement to overinvolvement. The nurse has lost her focus on what is important for the client.
The nurse has lost her objectivity. Disengagement is the opposite of overinvolvement.
DIF: Cognitive Level: Application
REF: p. 185
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
6. The professional relationship goes through a developmental process characterized by
overlapping yet distinct stages, which are
a. confidentiality, trust, and empathy.
b. listening, hearing, and feeling.
c. preinteraction, orientation, working phase, and termination phase.
d. getting details, thoughts, and answers.
ANS: C
The professional relationship goes through a developmental process characterized by four
overlapping yet distinct stages: (1) preinteraction, (2) orientation, (3) working phase, and (4)
termination phase. The preinteraction phase is the only phase of the relationship the client is not
part of. During the preinteraction phase, the nurse develops the appropriate physical and
interpersonal environment for an optimal relationship, in collaboration with other health
professionals and significant others in the client's life. Confidentiality, trust, and empathy are
guiding principles, not phases. Listening, hearing, and feeling are communication skills. Getting
details, thoughts, and answers occurs during the orientation phase.
DIF: Cognitive Level: Comprehension
REF: p. 181
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Psychosocial Integrity
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7. Which of the following personality characteristics can affect the nurse’s ability to function in a
therapeutic manner, if disclosed to the client?
a. The nurse is shy.
b. The nurse becomes angry when criticized.
c. The nurse has difficulty handling conflict.
d. The nurse struggles with getting up in the morning.
ANS: B
It is up to the nurse, not the client, to resolve interpersonal issues that get in the way of the
relationship. Nurses need to acknowledge overinvolvement, avoidance, anger, frustration, or
detachment from a client when it occurs. By disclosing that she is shy, the nurse may assist the
client to avoid misinterpreting cues. Disclosing that the nurse has difficulty handling conflict
may open the way for the client to reveal problems and coping skills. The self-disclosure that the
nurse struggles with getting up in the morning demonstrates humanness to the client.
DIF: Cognitive Level: Application
REF: p. 186
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
8. In the preinteraction phase of the nurse-client relationship
a. professional goals are communicated directly to the client.
b. the content of the interaction is vital; the environment has little importance.
c. the nurse develops the appropriate physical and interpersonal environment for an
optimal relationship.
d. it is the nurse’s knowledge of principles and responsibilities that guarantees a
successful relationship.
ANS: C
The professional relationship goes through a developmental process characterized by four
overlapping yet distinct stages: (1) preinteraction, (2) orientation, (3) working phase, and (4)
termination phase. The preinteraction phase is the only phase of the relationship the client is not
part of. During the preinteraction phase, the nurse develops the appropriate physical and
interpersonal environment for an optimal relationship, in collaboration with other health
professionals and significant others in the client's life.
DIF: Cognitive Level: Comprehension
REF: pp. 187-188
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
9. Which of the following is a nontherapeutic statement during the orientation phase of a
relationship?
a. “I am the nurse who will be caring for you today.”
b. “My job is to make you better.”
c. “I will be talking with you while I provide care.”
d. “You will be receiving care from an assistant and myself.”
ANS: B
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The orientation phase ends with a therapeutic contract mutually defined by nurse and client. The
nurse enters the relationship in the “stranger” role and begins the process of developing trust by
providing the client with basic information about the nurse (e.g., name and professional status)
and essential information about the purpose, nature, and time available for the relationship. It is
therapeutic to provide the client with basic and essential information. Providing information
helps develop trust.
DIF: Cognitive Level: Application
REF: pp. 188-189
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
10. The nurse practices “here and now” focus on problem identification, with an emphasis on
quickly understanding the context in which the problem is embedded during which of the
following phases of the nurse-client relationship?
a. Orientation
b. Preinteraction
c. Termination
d. Working
ANS: A
Orientation phase: The therapeutic alliance begins with the same type of introduction and
description of purpose identified for long-term relationships with a focus on the nurse and client
working as partners to develop a shared understanding of the client's health problems.
Establishing a working alliance where time is an issue requires a “here and now” focus on
problem identification, with an emphasis on quickly understanding the context in which the
problem is embedded. Meaningful connections occur when nurses initially strive to view each
client as a person to be engaged with rather than focusing on what needs to be done.
DIF: Cognitive Level: Knowledge
REF: p. 197
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
11. Self-disclosure by the nurse refers to the intentional revealing of personal experiences or feelings
that are similar to or different from those of the client. The purpose of self-disclosure is to
a. deepen trust, to be a role model of self-disclosure as a beneficial mode of
communicating.
b. to find out how the client would like to be.
c. to determine how things would be if the problems were solved.
d. to work toward resolution of the client’s self-care needs.
ANS: A
Self-disclosure by the nurse refers to the intentional revealing of personal experiences or feelings
that are similar to or different from those of the client. The purpose of self-disclosure is to
deepen trust and to be a role-model of self-disclosure as a beneficial mode of communicating for
people who have trouble disclosing information about themselves. Appropriate self-disclosure
can facilitate the relationship, providing the client with information that is both immediate and
personalized.
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DIF: Cognitive Level: Application
REF: p. 194
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
12. The client becomes more self-directed during which of the following phases of the nurse-client
relationship?
a. Orientation
b. Preinteraction
c. Identification
d. Working
ANS: D
The working phase focuses on self-direction and self-management to whatever extent is possible
in promoting the client’s health and well-being. Orientation is the assessment phase. The client is
not present during the preinteraction phase. Nurses help clients express feelings and clarify ideas
and expectations during the identification phase.
DIF: Cognitive Level: Application
REF: p. 198
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
13. Which stage of the nursing process corresponds to the exploitation part of the working phase of
the therapeutic relationship?
a. Diagnosis
b. Assessment
c. Implementation
d. Planning
ANS: C
The exploitation phase corresponds to the implementation phase of the nursing process, where
the purpose is to work toward resolution of the client’s self-care needs. Nursing diagnoses are
established during the orientation phase. Assessment corresponds to the orientation phase.
Planning corresponds to the working phase.
DIF: Cognitive Level: Comprehension
REF: p. 192
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
14. When should the nurse first start planning for termination of the nurse-client relationship?
a. From the initial encounter
b. After goals have been achieved
c. When the client requests it
d. During the working phase of the relationship
ANS: A
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It is important to be clear from the beginning about how long a therapeutic relationship will last.
During the course of the relationship, termination can be mentioned and clients should be told
well in advance of an impending termination date. It is inappropriate to plan for termination after
the goals have been achieved, when the client requests termination, or during the working phase
of the relationship.
DIF: Cognitive Level: Knowledge
REF: p. 195
TOP: Step of the Nursing Process: Evaluation
MSC: Client Needs: Psychosocial Integrity
15. A primary difference between a therapeutic helping relationship and a social relationship is
a. enjoyment.
b. amount of listening.
c. worth to participants.
d. the focus.
ANS: D
Therapeutic helping relationships have a specific purpose and health-related goal. Enjoyment,
amount of listening, and worth to participants can occur in both types of relationships.
DIF: Cognitive Level: Comprehension
REF: p. 188
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
16. Which of the following is true about the helping relationship?
a. The health care provider takes responsibility for maintaining appropriate
boundaries.
b. Both the health care provider and the client have equal responsibility for the
relationship.
c. Self-disclosure for both the health care provider and the client is expected.
d. Understanding does not always have to be put into words.
ANS: A
In a helping relationship, the health care provider takes responsibility for the conduct of the
relationship and for maintaining appropriate boundaries.
DIF: Cognitive Level: Knowledge
REF: p. 188
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
17. An appreciative client offers the nurse a box of chocolates. The nurse should
a. accept all gifts offered by the client.
b. refuse to accept the chocolates in a gentle, tactful manner.
c. accept or refuse based on the uniqueness of the relationship.
d. accept the gift but also remind the client of intangible gifts.
ANS: C
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In general, nurses should not accept money, or gifts of significant material value. There is no one
answer about whether gifts should or should not be exchanged. In fact, if the nurse handled every
situation in the same fashion, the nurse would be denying the uniqueness of each nurse-client
relationship. Each relationship has its own character and its own strengths and limitations, so
what might be appropriate in one situation would be totally inappropriate in another. Token gifts
such as chocolates or flowers may be acceptable. In general, nurses should not accept money or
gifts of significant material value. Some agencies have policies regarding accepting gifts; others
do not. Accept or refuse based on the uniqueness of the situation.
DIF: Cognitive Level: Application
REF: p. 196
TOP: Step of the Nursing Process: Evaluation
MSC: Client Needs: Management of Care
18. The nurse has been working in a long-term care facility for several years. The nurse has decided
to leave the facility to work elsewhere. When terminating her relationship with clients, the nurse
should
a. prepare clients for termination.
b. inform clients that she will “keep in touch.”
c. inform clients that they have benefited from the relationship.
d. discuss feelings with clients during the last encounter.
ANS: A
Termination of a meaningful nurse-client relationship in long-term settings should be final. To
provide the client with even a hint that the relationship will continue is unfair. It keeps the client
emotionally involved in a relationship that no longer has a health-related goal. There needs to be
a mutual evaluation of benefits from the relationship. Feelings need to be expressed and
discussed well before the last encounter.
DIF: Cognitive Level: Application
REF: pp. 198-199
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
19. The student nurse has finished her rotation on the outpatient psychiatric unit. Her client, who was
diagnosed with borderline personality disorder, suddenly displays superficial scratches to both
forearms. Which of the following is a nursing diagnosis for the client related to losses and
endings in the nurse-client relationship?
a. Noncompliance about impending termination of nurse-client relationship
b. Knowledge deficit about impending termination of nurse-client relationship
c. Self-care deficit related to impending termination of nurse-client relationship
d. Anxiety related to impending termination of nurse-client relationship
ANS: D
The client’s anxiety has led to the regression in her behavior. Noncompliance, knowledge deficit,
and self-care deficit are not diagnoses dealing with losses and endings.
DIF: Cognitive Level: Analysis
REF: p. 195
TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Psychosocial Integrity
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Chapter 11: Bridges and Barriers in Therapeutic Relationships
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following describes caring?
a. It is difficult to demonstrate professionally.
b. It is an ethical responsibility.
c. It is an intuitive process.
d. It is not influenced by past experience.
ANS: B
Caring is an ethical responsibility that guides a health care provider to advocate for the client.
Caring is demonstrated professionally in the therapeutic relationship. It is an intentional action
that is learned. A person who has received caring is more likely to be able to offer it to others.
DIF: Cognitive Level: Comprehension
REF: p. 202
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. Which of the following should be achieved first in establishing the nurse-client relationship?
a. Trust
b. Empathy
c. Mutuality
d. Empowerment
ANS: A
Establishing trust is the foundation in all relationships. The development of a sense of
interpersonal trust, a sense of feeling safe, is the keystone in the nurse-client relationship.
Empathy is used by the nurse after trust is established. Mutuality is important in establishing
client goals. Empowerment occurs when the client actively participates in his or her care plan.
DIF: Cognitive Level: Comprehension
REF: p. 205
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. Which of the following describes mutual goals?
a. Mutuality is based on client goals.
b. Mutuality is based on interdisciplinary health team goals.
c. Mutuality is based on the nurse’s goals.
d. Mutuality is based on the physician’s goals.
ANS: A
Evidence of mutuality is seen in the development of individualized client goals and nursing
actions that meet a client’s unique health needs—not on the goals of the health team, the nurse,
or the physician.
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DIF:
Cognitive Level: Comprehension
REF: p. 206
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TOP: Step of the Nursing Process: PlanningMSC:
Client Needs: Management of Care
4. Which of the following is a violation of client confidentiality?
a. Sharing of information about a communicable disease
b. Stating client’s diagnosis during change of shift report
c. Photographing a client’s wound to monitor the healing process
d. Discussing private information about the client casually with others
ANS: D
Discussing private information casually with others is an abuse of confidentiality. It is legal to
share information about public health issues such as a communicable disease. Information can be
shared with the health care team. Photographing a client’s wound is not a breach of
confidentiality; the pictures stay with the client’s record and are used for the benefit of the client.
DIF: Cognitive Level: Analysis
REF: p. 215
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
5. Stereotypes are learned during
a. exposure to early education.
b. childhood and reinforced by life experiences.
c. limited contact with other cultures.
d. uncomfortable experiences with culturally diverse clients.
ANS: B
Stereotypes are learned during childhood and reinforced by life experiences.
DIF: Cognitive Level: Knowledge
REF: p. 209
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. Which of the following describes proxemics?
a. Study of relationship between message and topic at hand
b. Study of implied meanings within individuals
c. Study of an individual’s use of space
d. Study of the emotional personal space boundary
ANS: C
Proxemics is the study of an individual’s use of space. The study of relationships between
messages and topics at hand and the study of implied meanings within individuals do not involve
the use of space. An individual can use space as an invisible boundary.
DIF: Cognitive Level: Knowledge
REF: p. 210
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
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7. Which of the following is a barrier to communication?
a. Intrusion into personal space
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b. Unconditional acceptance
c. Self-awareness
d. Gender differences
ANS: A
Understanding communication barriers in a relationship (e.g., anxiety, stereotyping, or violations
of personal space or confidentiality) affects the quality of the relationship. Unconditional
acceptance is an essential element in the helping relationship. Self-awareness enhances
communication. No evidence exists showing that gender differences obstruct the therapeutic
relationship.
DIF: Cognitive Level: Comprehension
REF: p. 210
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
8. Which of the following is true about trust?
a. The sender feels it.
b. It is difficult to demonstrate professionally.
c. It is an intuitive process.
d. The trusting client feels comfortable revealing needs.
ANS: D
The development of a sense of interpersonal trust, a sense of feeling safe, is the keystone in the
nurse-client relationship. Trust provides a nonthreatening interpersonal climate in which the
client feels comfortable revealing his needs. The sender promotes a trusting relationship. Trust is
demonstrated professionally in the nurse-client relationship. The development of trust is based on
past experiences, not intuition.
DIF: Cognitive Level: Comprehension
REF: p. 205
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
9. The nurse demonstrates an understanding of mutuality when stating to the client,
a. “Mr. Jones, I think you should go to bed now.”
b. “Mr. Jones, I would like you to go to bed now.”
c. “Mr. Jones, I don’t think you should sit in the chair.”
d. “Mr. Jones, I thought we agreed that you would return to bed at this time.”
ANS: D
Mutuality basically means that the nurse and the client agree on the client’s health problems and
the means for resolving them and that both parties are committed to enhancing the client’s wellbeing. When the nurse instructs the client what to do, it represents the nurse’s goals for the client
and does not demonstrate mutuality.
DIF: Cognitive Level: Application
REF: p. 206
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
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10. When entering a client’s room, the nurse notices the client standing while wringing her hands
and wearing street clothes over pajamas. On further examination, it is noted that the client is
hyperventilating with elevated vital signs. Which level of anxiety is the client experiencing?
a. Mild
b. Moderate
c. Severe
d. Panic
ANS: C
Signs of severe anxiety include elevated vital signs, impaired problem-solving, and a confused
mental state. Signs of mild anxiety are enhanced problem-solving and increased alertness. Signs
of moderate anxiety do not include high blood pressure. During panic, the client is immobilized
with no cognitive or coping abilities.
DIF: Cognitive Level: Analysis
REF: pp. 208-209
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Physiological Adaptation
11. Which of the following situations is an example of the nurse using empathy?
a. Setting up a rehabilitation placement for a client addicted to heroin
b. Sitting quietly and holding a client’s hand while she cries following the news that
she has inoperable cancer
c. Giving a bed bath to a client who suffers from a cerebral vascular accident (CVA)
d. Telling a client all about the fun night at one of the local clubs
ANS: B
Empathy is the ability to be sensitive to and communicate understanding of the client’s feelings.
The client should be encouraged to be involved in his or her own care and to assume
responsibility. The nurse should not tell a client about extracurricular activities because this is an
example of nontherapeutic self-disclosure by the nurse.
DIF: Cognitive Level: Application
REF: pp. 205-206
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
12. The nurse knocks on the client’s door and waits for the client to answer before entering the room.
The nurse is demonstrating
a. nonverbal communication skills.
b. respect for the client’s personal space.
c. respect for the client’s confidentiality.
d. respect for the client’s gender difference.
ANS: B
Giving warning before entering a client’s room demonstrates respect for personal space.
Knocking is not a demonstration of nonverbal communication. Knocking at a door before
entering the room does not relate to respect for a client’s confidentiality. Respect for a client’s
personal space should be demonstrated regardless of gender.
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DIF:
Cognitive Level: Application
REF: p. 214
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TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
13. Which of the following is true regarding personal space?
a. Individuals living in a Western culture need 40 square feet of personal space.
b. Direct eye contact causes a need for less space.
c. People need less space when they are anxious.
d. The elderly need more control over their personal space.
ANS: D
The elderly need control over personal space because they can become profoundly disoriented in
unfamiliar environments. Individuals living in a Western culture need 86-108 square feet of
personal space. Direct eye contact causes a need for more space. People need more space when
they are anxious.
DIF: Cognitive Level: Knowledge
REF: p. 210
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
14. Which of the following demonstrates the use of the caring process?
a. Respecting the uniqueness of every client
b. Problem solving for the client
c. Performing tasks for the client
d. Communicating expectations of the health care team
ANS: A
Caring is described as a commitment by the nurse that involves profound respect and concern for
the unique humanity of every client and a willingness to confirm the client’s personhood. Caring
is demonstrated by problem-solving with the client, not for the client. Encouraging self-care
empowers the client. The nurse needs to respond to the client’s expectations for health care.
DIF: Cognitive Level: Application
REF: p. 205
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
15. In order to reduce clinical bias in nursing practice, the nurse should
a. memorize beliefs held by different cultures.
b. generalize beliefs based on ethnic membership.
c. develop a nonjudgmental, neutral attitude.
d. recognize that individuals of the same religion share the same characteristics.
ANS: C
Developing a nonjudgmental, neutral attitude toward a client helps the nurse reduce clinical bias
in nursing practice. The nurse does not have to memorize beliefs to become culturally sensitive.
Stereotypes are generalized beliefs based on ethnic membership. All individuals of a particular
social group, race, or religion do not share the same characteristics.
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DIF: Cognitive Level: Knowledge
REF: p. 215
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Management of Care
MULTIPLE RESPONSE
1. Which of the following nursing behaviors are included in the levels of nursing actions within
Level 1? (Select all that apply.)
a. Confronts conflict
b. Uses client’s correct name
c. Maintains eye contact
d. Adopts open posture
e. Responds to cues
ANS: B, C, D, E
Using a client’s correct name, maintaining eye contact, adopting open posture, and responding to
cues are responses that are demonstrated by the accepting category within Level 1 of levels of
nursing action. Confronting conflict is an example of a nursing behavior at the analyzing
category of Levels 4-5.
DIF: Cognitive Level: Knowledge
REF: p. 213
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
Chapter 12: Communicating with Families
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Regardless of how uniquely they are defined, strong emotional ties and durability of membership
characterize
a. family function.
b. family process.
c. family relationships.
d. family ecomap.
ANS: C
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A family is who they say they are. Identified family members may or may not be blood related.
Strong emotional ties and durability of membership characterize family relationships regardless
of how uniquely they are defined. Even when family members are alienated, or distanced
geographically, they can never truly relinquish family membership. Family function refers to the
roles people take in their families. Family process describes the communication that takes place
within the family. An ecomap is essentially a sociogram, illustrating the shared relationships
between family members and the external environment. Beginning with an individual family unit
or client, the diagram extends to include significant social and community-based systems with
which they have a relationship. These data identify at a glance the family’s interaction with
environmental supports and its use of resources available through friends and community
systems.
DIF: Cognitive Level: Comprehension
REF: p. 217
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. When focusing on family interrelationships and the impact a serious health alteration has on
individual family members and the equilibrium of the family system, the nurse should use
a. equifinality.
b. diffuse boundaries.
c. circular questions.
d. morphostasis.
ANS: C
Interventive questioning is a nursing intervention that nurses can use with their client families to
identify family strengths; help family members sort out their personal fears, concerns, and
challenges in health care situations; and provide a vehicle for exploring alternative options.
Questionins can be either linear or circular. Circular questions focus on family interrelationships
and the impact a serious health alteration has on individual family members and the equilibrium
of the family system. The systems principle of equifinality describes how the same outcome, or
end state, can be reached through different pathways. This principle helps explain why some
individuals at high risk for poor outcomes do not develop maladaptive behaviors. Boundaries,
defined as invisible limits surrounding the family unit, protect the integrity of the family system.
Boundaries draw a line in the sand by identifying what belongs within the family system and
what is external to it. They define the level of participation between family members. Clear
generational boundaries provide security for family members by, for example, setting legitimate
limits with children and balancing individual needs with the demands of caring for the needs of
chronically ill family members. Boundaries regulate the flow of information into and out of the
family. Permeable boundaries welcome interactions with others and allow information to flow
freely. Families with clear, permeable boundaries are better able to balance the demands of the
illness with other family needs and can communicate more effectively with care providers.
Diffuse boundaries lead to family overinvolvement, while rigid boundaries are operative in
families with little interaction between members and family secrets. Rigid boundaries restrict
flow of information. Interaction with outsiders is discouraged, or heavily regulated. Diffuse
boundaries are found in enmeshed families. Morphostasis refers to how the family is able to
change and grow over time in response to challenges.
DIF:
Cognitive Level: Knowledge
REF: p. 230
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TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. A family systems theory that conceptualizes the family as an interactive emotional unit in which
family members assume reciprocal family roles, develop automatic communication patterns, and
react to each other in predictable, connected ways, particularly when family anxiety is high, was
created by
a. Evelyn Duvall.
b. Murray Bowen.
c. McCubbin & McCubbin.
d. Salvador Minuchin.
ANS: B
Murray Bowen’s family systems theory conceptualizes the family as an interactive emotional
unit. Bowen believed that family members assume reciprocal family roles, develop automatic
communication patterns, and react to each other in predictable, connected ways, particularly
when family anxiety is high. Evelyn Duvall proposed a family life stage framework for
understanding issues that normal families experience based on expected family development
through the life span, each with its own set of tasks. Duvall’s model describes the life cycle of a
family, using the age of the oldest child in the family as the benchmark for determining the
family’s developmental stage. Developmental tasks represent the challenges and growth
responsibilities each family experiences at different life stages. McCubbin & McCubbin’s
Resiliency Model of Family Stress, Adjustment, and Adaptation is considered the most
extensively studied model of family coping with traumatic and chronic illness. In this model, A
(an event) interacts with B (resources) and with C (family’s perception of the event) to produce
X (the crisis). Family structure models, pioneered by Salvador Minuchin, emphasize the
structure (subsystems, hierarchies, and boundaries) of the family unit as the basis for
understanding family function. Family structure refers to how the family is constructed legally
and emotionally. The concept of hierarchy describes how families organize themselves into
various smaller units, referred to as subsystems, that compose the larger family system.
DIF: Cognitive Level: Knowledge
REF: p. 220
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
4. The nurse is caring for a client who is extremely dependent on the approval of others, causing
them to discount their own needs. The nurse recognizes that the client is demonstrating
a. self-differentiation.
b. emotional cutoff.
c. poor self-differentiation.
d. rigid boundaries.
ANS: C
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Self-differentiation refers to a person’s capacity to define himself or herself within the family
system as an individual having legitimate needs and wants. It requires making “I” statements
based on rational thinking rather than emotional reactivity. Self-differentiation takes into
consideration the views of others but is not dominated by them. Poorly differentiated people are
so dependent on the approval of others that they discount their own needs. Emotional cutoff
refers to a person’s withdrawal from other family members as a means of avoiding family issues
that create anxiety. Emotional cutoffs range from total avoidance to remaining in physical
contact, but in a superficial manner. Emotional cutoffs contain a negative anxiety that drains
personal energy. The problems creating the emotional cutoff persist. Rigid boundaries are
operative in families with little interaction between members and family secrets. Rigid
boundaries restrict flow of information. Interaction with outsiders is discouraged, or heavily
regulated.
DIF: Cognitive Level: Application
REF: p. 220
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
5. The nurse is caring for a client who reports having marital difficulties. When experiencing
heightened anxiety related to his health issues, the client chooses to discuss his feelings with a
female friend rather than with his spouse. The nurse recognizes the client’s actions as a defensive
way of reducing, neutralizing, or defusing heightened anxiety known as
a. systems’ thinking.
b. triangles.
c. feedback loops.
d. multigenerational transmission.
ANS: B
Triangles refer to a defensive way of reducing, neutralizing, or defusing heightened anxiety
between two family members by drawing a third person, or object into the relationship. If the
original triangle fails to contain or stabilize the anxiety, it can expand into a series of
“interlocking” triangles, for example into school issues or an affair. Systems’ thinking maintains
that the whole is greater than the sum of its parts, with each part reciprocally influencing its
function. If one part of the system changes or fails, it affects the functioning of the whole.
Feedback loops describe the patterns of interaction that facilitate movement toward
morphogenesis, or morphostasis; they impact goal setting in behavior systems. Multigenerational
transmission refers to the emotional transmission of behavioral patterns, roles, and
communication response styles from generation to generation. It explains why family patterns
tend to repeat behaviors in marriages, child rearing, choice of occupation, and emotional
responses across generations, without understanding why it happens.
DIF: Cognitive Level: Application
REF: p. 220
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
6. When performing an admission assessment on a client, the nurse asks about sibling position
based on the knowledge that sibling position can shape relationships and influence a person's
expression of behavioral characteristics. The concept that each sibling position has its own
strengths and weaknesses is based on the work of:
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a.
b.
c.
d.
Murray Bowen.
Walter Toman.
Medalie & Cole-Kelly.
McCubbin & McCubbin.
ANS: B
Sibling position, a concept originally developed by Walter Toman (1992), refers to a belief that
sibling positions shape relationships and influence a person's expression of behavioral
characteristics. Each sibling position has its own strengths and weaknesses. This concept helps
explain why siblings in the same family can exhibit very different characteristics. Murray
Bowen’s family systems theory conceptualizes the family as an interactive emotional unit.
Bowen believed that family members assume reciprocal family roles, develop automatic
communication patterns, and react to each other in predictable, connected ways, particularly
when family anxiety is high. Medalie and Cole-Kelly describe the course of chronic illness as
being a series of crises with relatively stable times in between McCubbin & McCubbin’s
Resiliency Model of Family Stress, Adjustment, and Adaptation is considered the most
extensively studied model of family coping with traumatic and chronic illness. In this model, A
(an event) interacts with B (resources) and with C (family’s perception of the event) to produce
X (the crisis).
DIF: Cognitive Level: Application
REF: pp. 220-221
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
7. When performing an assessment that focuses on a set of standardized connections to graphically
record basic information about family members and their relationships over three generations,
the nurse uses
a. an ecomap.
b. a gendergram.
c. family time lines.
d. a genogram.
ANS: D
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A genogram uses a standardized set of connections to graphically record basic information about
family members and their relationships over three generations. Genograms are updated and/or
revised as new information emerges. An ecomap is essentially a sociogram, illustrating the
shared relationships between family members and the external environment. Beginning with an
individual family unit or client, the diagram extends to include significant social and communitybased systems with whom they have a relationship. These data identify at a glance the family’s
interaction with environmental supports and its use of resources available through friends and
community systems. Adding the ecomap is an important dimension of family assessment,
providing awareness of community supports that are, or are not, being used to assist families. A
gendergram is used to understand gender role development in families and its influences on
current role enactments. Family time lines offer a visual diagram that captures significant family
stressors, life events, health, and developmental patterns through the life cycle. Family history
and patterns developed through multigenerational transmission are represented as vertical lines.
Horizontal lines indicate timing of life events occurring over the current life span. These include
such milestones as marriages, graduations, and unexpected life events such as disasters, war,
illness, death of person or pet, moves, or births. Timelines are useful in looking at how the family
history, developmental stage, and concurrent life events might interact with the current health
concern.
DIF: Cognitive Level: Application
REF: p. 223
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
8. When interviewing the family of a client newly diagnosed with Alzheimer disease, the nurse’s
primary goal is to help the family members sort out their personal fears and identify family
strengths through the use of
a. interventive questioning.
b. genogram.
c. ecomap.
d. offering commendations.
ANS: A
Interventive questioning is an intervention that nurses can use with their client families to
identify family strengths; help family members sort out their personal fears, concerns, and
challenges in health care situations; and provide a vehicle for exploring alternative options. A
genogram uses a standardized set of connections to graphically record basic information about
family members and their relationships over three generations. Genograms are updated and/or
revised as new information emerges. An ecomap is essentially a sociogram illustrating the shared
relationships between family members and the external environment. Beginning with an
individual family unit or client, the diagram extends to include significant social and communitybased systems with whom they have a relationship. These data identify at a glance the family’s
interaction with environmental supports and its use of resources available through friends and
community systems. Adding the ecomap is an important dimension of family assessment,
providing awareness of community supports that are, or are not, being used to assist families.
Offering commendations is the practice of noticing, drawing forth, and highlighting previously
unobserved, forgotten, or unspoken family strengths, competencies, or resources.
DIF:
Cognitive Level: Application
REF: p. 230
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TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
9. When interviewing the family of a client who is suffering from alcoholism, the communication
technique used by the nurse is called circular questioning. The advantage of this technique is that
it
a. examines relationships.
b. aids the nurse in establishing a diagnosis.
c. focuses on the equilibrium of the family system.
d. helps the nurse gain specific information.
ANS: C
Circular questions focus on family interrelationships and the impact of a serious health alteration
on individual family members and the equilibrium of the family system. The nurse uses
information the family provides as the basis for additional questions. A technique used to
examine relationships is called ecomap. Circular questioning assists the nurse in developing
interventions, not diagnoses. Circular questioning helps the nurse gain multidimensional, not
specific, information.
DIF: Cognitive Level: Application
REF: p. 230
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
10. Which of the following describes the dyad family unit?
a. A father and mother with one or more children living together
b. Second- and third-generation members related by blood or marriage but not living
together
c. Divorced, never married, separated, or widowed male or female and at least one
child
d. Husband and wife or other couple living alone without children
ANS: D
A dyad family is a husband and wife or other couple living alone without children. A nuclear
family is a father and mother with one or more children living together. An extended family is
second- and third-generation members related by blood or marriage but not living together. A
single-parent family is a divorced, never married, separated, or widowed male or female and at
least one child.
DIF: Cognitive Level: Knowledge
REF: p. 218
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Management of Care
11. Which of the following is a true statement when comparing biological and blended families?
a. In biological families, rules are varied and complicated.
b. A blended family is born of loss.
c. In biological families, there are multiple sets of rules.
d. In blended families, traditions are shared.
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ANS: B
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In blended families, family is born of loss and rules are varied and complicated. In biological
families, one set of family rules evolves. There are two sets of family traditions in blended
families.
DIF: Cognitive Level: Knowledge
REF: p. 219
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Management of Care
12. When the nurse cares for a client with a terminal illness, a question that the nurse can ask the
client’s family to elicit information about family strengths is
a. “Who best understands what the doctors have told you?”
b. “What has the family been doing so far that is helpful?”
c. “Who is most uncomfortable at the bedside?”
d. “Who is now taking care of the house?”
ANS: B
Questions nurses can use specifically to elicit family strengths include, “What has the family
been doing so far that has been helpful?” Questions regarding level of understanding, comfort,
and who is taking care of the house are not the best questions that the nurse can ask the client’s
family to elicit information about family strengths.
DIF: Cognitive Level: Application
REF: p. 230
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
13. The nurse-family relationship in client care depends on what type of relationship between the
nurse and the family?
a. A dependent relationship
b. A relationship that begins informally
c. A reciprocal relationship
d. A relationship that promotes inequality between the nurse and family
ANS: C
The nurse-family relationship in client care depends on a reciprocal relationship between the
nurses and family in which both are equal partners and sources of information. The initial
encounter sets the tone for the relationship. How nurses interact with each family member may
be as important as what they choose to say. The nurse should begin with formal introductions and
explain the purpose of gathering assessment data.
DIF: Cognitive Level: Application
REF: p. 228
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
14. When caring for clients, it is important for the nurse to understand that
a. treatment plans should be tailored around personal family goals.
b. meaningful involvement in the client’s care will be consistent among family
members.
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c. the nurse should listen to only immediate family members when considering
implications for family involvement.
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d. individual family members have different perspectives.
ANS: D
Meaningful involvement in the client’s care not only differs from family to family, it also differs
among individual family members. Individual family members have different perspectives.
Hearing each family member’s perspective helps the family and nurse develop a unified
understanding of significant treatment goals and implications for family involvement. Although
treatment plans should be tailored around personal client goals, acknowledging family needs,
values, and priorities enhances compliance, especially if they are different.
DIF: Cognitive Level: Application
REF: p. 231
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. The home health nurse is visiting a family who is having difficulty coping. The family has a 2-
month-old malnourished child whom they are feeding diluted formula along with rice cereal. The
parents of the child are unemployed and are unable to pay their monthly expenses. The father of
the child complains of not being able to find a job, while the mother of the child accuses him of
not even trying to find employment. Which of the following techniques would be most helpful
for the nurse to use in this situation? (Select all that apply.)
a. Linear questioning
b. Interventive questioning
c. Circular questioning
d. Encouraging their coping style
e. Identifying family strengths
ANS: A, B, C, E
Interventive questioning is a nursing intervention that nurses can use with their client families to
identify family strengths; help family members sort out their personal fears, concerns, and
challenges in health care situations; and provide a vehicle for exploring alternative options.
Interventive questioning can be either linear or circular. Encouraging the family’s current coping
style is not useful because it clearly has detrimental effects, including a malnourished child.
DIF: Cognitive Level: Application
REF: p. 230
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
2. The nurse is designing therapeutic interventions for a family whose child is hospitalized with a
terminal condition. The nurse recognizes that nursing actions that can be offered to the family
that can promote positive change in family functioning include which of the following? (Select
all that apply.)
a. Encouraging the telling of illness narratives
b. Commending family on individual strengths
c. Offering information and opinions
d. Discouraging the use of respite care
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ANS: A, B, C
Suggested nursing actions to promote positive change in family functioning include
• encouraging the telling of illness narratives.
• commending family and individual strengths.
• offering information and opinions.
• validating or normalizing emotional responses.
• encouraging family support.
• supporting family members as caregivers.
• encouraging respite.
DIF: Cognitive Level: Application
REF: p. 231
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
Chapter 13: Resolving Conflicts between Nurse and Client
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. The nurse is caring for an intoxicated client who has been admitted to the emergency department.
The client appears very angry and frequently shouts at the nurse and demands to see the
physician. The best response by the nurse is to use
a. blaming.
b. empathy.
c. competition.
d. “I” statements.
ANS: B
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Effective nurse-client communication is critical to efficient care provision and to providing
quality care. Knowing how to respond in emotional situations allows the nurse to use feelings as
a positive force. Nurses often find themselves in dramatic situations in which a calm response is
required. Some clients approach their initial encounter with a nurse with hostility or
embarrassment, such as the intoxicated client admitted to an emergency department. To listen
and to respond creatively to intense emotion when the nurse’s first impulse is to withdraw or to
retaliate demands a high level of skill. It requires self-control and empathy for what the client
may be experiencing. The nurse should avoid blaming, which will only make the client feel
defensive or angry. Competition is a response style characterized by domination. In this
contradictory style, one party exercises power to gain his own goals at the expense of the other
person. It is characterized by aggression and lack of compromise. Authority may be used to
suppress the conflict in a dictatorial manner. This leads to increased stress. It is an effective style
when there is a need for a quick decision, but it leads to problems in the long term, making it a
lose-lose situation. Timing is also important if an individual is very angry. The key to assertive
behavior is choice. Sometimes it is better to allow the client to let off some “emotional steam”
before engaging in conversation.
DIF: Cognitive Level: Application
REF: p. 258
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
2. When working in situations that involve conflict, the nurse recognizes that which of the
following is true in relation to conflict?
a. Conflict always leads to impaired relationships.
b. Conflict arises from compatible goals and needs.
c. Most people experience conflict as a lack of discomfort.
d. Conflict serves as a warning that something in the relationship needs closer
attention.
ANS: D
Conflict has been defined as tension arising from incompatible goals or needs, in which the
actions of one frustrate the ability of the other to achieve a goal, resulting in stress or tension.
Conflicts in any relationship are inevitable: they serve as warning that something in the
relationship needs closer attention. Conflict can lead to improved relationships. Conflict has been
defined as tension arising from incompatible goals or needs. Most people experience conflict as
discomfort.
DIF: Cognitive Level: Knowledge
REF: p. 241
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. A nurse manager is educating nurses about the risk of violence experienced by nurses and social
workers in their workplace when compared to other professionals. The nurse manager states that
nurses and social workers are at
a. three times greater risk to experience violence in their workplace than are other
professionals.
b. four times greater risk to experience violence in their workplace than are other
professionals.
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c. no greater risk to experience violence in their workplace than are other
professionals.
d. two times greater risk to experience violence in their workplace than are other
professionals.
ANS: A
Violence against health care workers is increasing. Nurses are at greater risk because of their
close contact with clients. In fact, nurses and social workers are at three times greater risk to
experience violence in their workplace than are other professionals.
DIF: Cognitive Level: Knowledge
REF: p. 242
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
4. The most effective problem-solving style for genuine resolution that creates a win-win situation
is
a.
b.
c.
d.
accommodation.
avoidance.
competition.
collaboration.
ANS: D
Collaboration is a solution-oriented response in which individuals work together cooperatively to
problem solve. To manage a conflict, those involved commit to finding a mutually satisfying
solution. This involves directly confronting the issue, acknowledging feelings, and using open
communication to solve the problem. Steps for productive confrontation include: identifying
concerns of each party; clarifying assumptions; communicating honestly to identify the real
issue; and working collaboratively to find a solution that satisfies everyone. This is considered to
be the most effective style for genuine resolution. This is a win-win situation. Accommodation is
a lose-win situation. Avoidance can turn into a lose-lose situation. Competition can lead to a loselose situation.
DIF: Cognitive Level: Knowledge
REF: p. 245
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
5. When a physician writes an order for the nurse to withhold life-saving treatment from a
terminally ill client, the nurse is faced with two different choices, each supported by a different
ethical principle. This type of conflict is known as
a. covert conflict.
b. overt conflict.
c. interpersonal conflict.
d. intrapersonal conflict.
ANS: D
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A conflict can be internal (intrapersonal); that is, it can represent opposing feelings within an
individual. Intrapersonal conflict arises when nurses are faced with two different choices, each
supported by a different ethical principle. More often, conflict is covert and not so clear-cut. The
conflict issues are hidden. The client talks about one issue, but talking does not seem to help and
the issue does not get resolved. Overt conflict refers to conflict that is observable in the client's
behavior and expressed verbally. Interpersonal conflict occurs between two or more people.
DIF: Cognitive Level: Application
REF: p. 251
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
6. Which of the following best describes the goal of assertiveness?
a. Offering responses that contain “you” statements
b. Indirect communication
c. Standing up for one’s personal rights
d. Ignoring the rights of others
ANS: C
Assertive behavior is defined as setting goals; acting on those goals in a clear, consistent manner;
and taking responsibility for the consequences of those actions. Assertive communication is
conveying this objective in a direct manner, without anger or frustration. The assertive nurse is
able to stand up for personal rights and the rights of others.
DIF: Cognitive Level: Knowledge
REF: p. 247
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
7. Which of the following is true about assertion communication?
a. Components include the ability to say no and to ask for what you want.
b. It includes a demonstration of deference to the demands of others.
c. It consistently violates the needs of others.
d. It includes the expression of only positive thoughts and feelings.
ANS: A
Components of assertion communication include the following four abilities to: (1) say no, (2)
ask for what you want, (3) appropriately express both positive and negative thoughts and
feelings, and (4) initiate, continue, and terminate the interaction.
DIF: Cognitive Level: Knowledge
REF: p. 247
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
8. A client yells at the nurse frequently and uses profane language. Which of the following is the
most appropriate response by the nurse?
a. Remain silent and do not respond
b. Use an “I” statement when speaking to the client
c. Tell the client, “You make me angry.”
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d. Ignore the behavior and walk away
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ANS: B
Assertive responses contain “I” statements that take responsibility. This behavior is in contrast to
aggressive behavior, which has a goal of dominating while suppressing the other person’s rights.
The goal of assertiveness is to communicate directly, standing up for one’s personal rights while
respecting the rights of others. Conflict creates anxiety, which may prevent one from behaving
assertively. Aggressive behavior has a goal of dominating while suppressing the other person’s
rights. Aggressive responses often consist of “you” statements that fix blame on the other person.
Assertive behaviors range from making a direct, honest statement about one’s beliefs to taking a
very strong, confrontational stand about what will and will not be tolerated in the relationship.
DIF: Cognitive Level: Application
REF: p. 247
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
9. A client states to the nurse in a hostile voice, “I am sick of being poked at and stuck with needles.
Go away and leave me alone.” Which of the following is the best statement by the nurse?
a. “I am not surprised that you wish to be left alone.”
b. “I’m so sorry you are feeling so upset.”
c. “You feel vulnerable and depressed as a result of all these treatments.”
d. “Okay, I will go away.”
ANS: B
Validating the anger and reframing are useful. Comments such as, “I’m sorry you are feeling so
upset,” recognize the significance of the emotion being expressed without getting into the cause.
“I am not surprised that you wish to be left alone” validates the client’s anger, but does not
reframe the situation. The nurse should not make inferences about what the client is feeling
without first validating. “Okay, I will go away” is avoidant behavior by the nurse.
DIF: Cognitive Level: Application
REF: p. 251
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
10. A client on a psychiatric unit is found pacing the halls and angrily punching at the wall. The
nurse’s primary goal should be to
a. assertively tell the client to stop the behavior.
b. suggest that the client write in a journal to help relieve anxiety.
c. speak in a loud voice in order to alert other staff members.
d. maintain safety while helping the client.
ANS: D
The nurse should help the client own the angry feelings by getting the client to verbalize things
that make him or her angry. Acknowledging a client’s anger may prevent an expression of
abusive ranting. It is essential that the nurse use empathetic statements or active listening to
acknowledge the client’s anger and maintain a nonthreatening demeanor before moving on to try
to discuss the issue. The goal is to maintain safety while helping the client. Psychiatric clients
can be unpredictable and at this point would not be likely to respond positively to a suggestion
such as writing in a journal. Speaking assertively or in a loud voice may escalate the situation,
and the client is already out of control.
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DIF: Cognitive Level: Application
REF: p. 257
TOP: Step of the Nursing Process: Intervention
MSC: Client Needs: Safety and Infection Control
11. After fasting from 10 p.m. the previous evening, a client learns that the procedure has been
cancelled. The client curses at the nurse and accuses the nurse of being incompetent. The nurse’s
best response would be
a. “You have no right to say that to me. You are nasty.”
b. “I can understand that you’re upset, but I feel uncomfortable when I am cursed at.”
c. “Perhaps we shouldn’t get so angry when things don’t work out the way we think
they should.”
d. to leave the room and refuse to return to answer the call light when the client calls.
ANS: B
Assertive behaviors range from making a direct, honest statement about one’s beliefs to taking a
very strong, confrontational stand about what will and will not be tolerated in the relationship.
Assertive responses contain “I” statements that take responsibility. This behavior is in contrast to
aggressive behavior, which has a goal of dominating while suppressing the other person’s rights.
Aggressive responses often consist of “you” statements that fix blame on the other person. “We”
statements should be used only when the nurse actually means to look at an issue collaboratively.
Thus, the statement, “Perhaps we both need to look at this issue a little closer.” may be
appropriate in certain situations. However, the statement, “Perhaps we shouldn’t get so angry
when things don’t work out the way we think they should.” is a condescending statement thinly
disguised as a collaborative statement. What is actually being expressed is the expectation that
both parties should handle the conflict in one way—the nurse’s way. Some nurses were
socialized to act passively. Passive behavior is defined as a response that denies our own rights in
order to avoid conflict.
DIF: Cognitive Level: Application
REF: p. 246
TOP: Step of the Nursing Process: Intervention
MSC: Client Needs: Psychosocial Integrity
12. When providing home health care to a client suffering from Alzheimer disease who fell and
broke his hip 3 weeks ago, the nurse teaches the client’s family correct use of the walker. This
represents which stage of the nurse-caregiver relationship?
a. Worker-helper
b. Worker-worker
c. Nurse as manager; family as worker
d. Nurse as nurse for family caregiver
ANS: B
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A Canadian study of home health nurses and family caregivers of elderly relatives identified four
evolving stages in the nurse-caregiver relationship. The initial stage is “worker-helper,” with the
nurse providing care to the ill client with the family helping. Next comes “worker-worker,” when
the nurse begins teaching the needed care skills to family members. Third is “nurse as manager;
family as worker,” as the family members learn needed care skills. The final stage, “nurse as
nurse for family caregiver,” occurs as the family member becomes exhausted. In the workerhelper stage, the nurse provides care to the ill client with the family helping. In the nurse as
manager; family as worker stage, the nurse acts as manager with the family learning care skills.
In the nurses as nurse for family caregiver stage, the family member is exhausted and the nurse
cares for him or her as well as the client.
DIF: Cognitive Level: Application, Knowledge
TOP: Step of the Nursing Process: Interventions
REF: p. 259
MSC: Client Needs: Management of Care
13. A client yells, “Take this mess away from here. How could anyone eat this food? What kind of
place are you running here?” The nurse uses skills of assertiveness to promote change that is
focused on
a. feelings.
b. attitudes.
c. behaviors.
d. motivations.
ANS: C
Undesired behaviors, not feelings, attitudes, and motivations, are the focus for change. Feelings,
attitudes, and motivations are not the focus for change.
DIF: Cognitive Level: Application
REF: p. 247
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Management of Care
14. The nurse is teaching an unlicensed assistive personnel (UAP) on potential approaches for
dealing with difficult clients. The nurse recognizes that additional teaching is required when the
UAP states
a. “I will be assertive by conveying my irritation toward the client’s behavior.”
b. “I will collaborate with staff so we all use the same uniform approach when
responding to the client’s demands.”
c. “I will promote trust in the client by providing immediate feedback.”
d. “I will explain to the client the limits of my role as an UAP.”
ANS: A
Potential approaches for dealing with difficult clients include using a calm tone and avoiding
conveying irritation. Potential approaches for dealing with difficult clients also include: working
with staff so all use the same uniform approach to the client’s demands; promoting trust by
providing immediate feedback; and explaining the limits of one’s role.
DIF: Cognitive Level: Application
REF: p. 252
TOP: Step of the Nursing Process: Planning
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MSC: Client Needs: Psychosocial Integrity
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15. When interacting with the nurse, a client makes several condescending remarks directed toward
the nurse. The nurse recognizes this behavior as an example of
a. the use of humor.
b. active listening.
c. a verbal clue to anger.
d. assertiveness.
ANS: C
Nonverbal clues to anger include grimacing, clenching jaws or fists, turning away, and refusing
to maintain eye contact. Verbal clues by a client may, of course, include use of an angry tone of
voice, but they may also be disguised as witty sarcasm or as condescending or insulting remarks.
The client’s remarks are condescending, not humorous. The client’s remarks are verbal, not
nonverbal. Use of condescending remarks is an example of passive-aggressive communication.
DIF: Cognitive Level: Application
REF: p. 257
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
16. The nurse’s first response in dealing with a conflict situation that involves a client is to
a. understand the context of the situation.
b. impose more controls on the client.
c. gain a clear understanding of one’s own personal response.
d. encourage the client to discount statements made by the nurse.
ANS: C
Conflicts between nurse and client are not uncommon. The first step for the nurse is to gain a
clear understanding of one’s own personal response. No one is equally effective in all situations.
The second step is to understand the context of the situation. Most interpersonal conflicts involve
some threat to one’s sense of control or self-esteem. Nurses have been shown to respond to the
stress of not having enough time to complete their work by imposing more controls on the client,
who then often reacts by becoming more difficult. Other situations, which may lead to conflict
between the nurse and the client, include having statements discounted.
DIF: Cognitive Level: Knowledge
REF: p. 243
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
17. The initial interpersonal strategy to help the client reduce strong emotion to a workable level
involves
a. talking the emotion through with someone.
b. providing a neutral, accepting, interpersonal environment.
c. taking action that might help the client come to terms with the emotional
consequences.
d. obtaining more information.
ANS: B
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The initial interpersonal strategy used to help clients reduce strong emotion to a workable level is
to provide a neutral, accepting, interpersonal environment. The second step in defusing the
strength of an emotion is to talk the emotion through with someone. The third phase is to take
action. The specific needs expressed by the emotion suggest actions that might help the client
come to terms with the consequences of the emotion. This responsibility might take the form of
obtaining more information or of taking some concrete risks to change behaviors that sabotage
the goals of the relationship.
DIF: Cognitive Level: Knowledge
REF: p. 253
TOP: Step of the Nursing Process: Intervention
MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which of the following are strategies the nurse should use when dealing with an angry client?
(Select all that apply.)
a.
b.
c.
d.
e.
Defuse hostility
Avoid responding to a client’s anger by getting angry
Speak quickly and use a higher tone of voice
Use empathy when communicating with the client
Remain with the client
ANS: A, B, D
The nurse should defuse hostility by avoiding responding to a client’s anger by becoming angry
also. The nurse should use empathy in his or her communication. An angry client needs to have
the nurse acknowledge both the issue and his or her feelings about that issue. Only then can the
client begin to interact in a meaningful way. Empathy by the nurse may help defuse the situation.
The nurse should deliberately begin to lower his or her voice and speak more slowly. When we
get upset, we tend to speak quickly and use a higher tone of voice. If the nurse does the opposite,
the client may begin to mimic him or her and thus calm down. The goal is to maintain safety
while helping the client. Therefore, it may not always be appropriate to remain with the client
because this may place the nurse in danger of physical harm. If the nurse feels in danger of
physical harm, he or she should always maintain a space for safety and plan an exit.
DIF: Cognitive Level: Knowledge
REF: p. 255
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Safety and Infection Control
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Chapter 14: Communicating to Encourage Health Literacy, Health Promotion, and
Prevention of Disease
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. When conducting an initial assessment, a client informs the nurse about difficulty getting to
doctors’ appointments due to lack of transportation. When considering examples of PRECEDE
Diagnostic Behavioral Factors, the nurse recognizes this as what type of factor?
a. Reinforcing factor
b. Epidemiologic factor
c. Enabling factor
d. Predisposing factor
ANS: C
Enabling factor involves environmental factors that facilitate or present obstacles to change (e.g.,
transportation, scheduling, and availability of follow-up).
DIF: Cognitive Level: Comprehension
REF: pp. 274-275
TOP: Step of the Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
2. The concept of well-being consists entirely of the ability to
a. work at producing an income.
b. perform activities of daily living.
c. define one’s subjective experience of life satisfaction.
d. partner with a health professional.
ANS: C
Well-being is defined as a person’s subjective experience of satisfaction about his or her life
related to six personal dimensions: (1) intellectual, (2) physical, (3) emotional, (4) social, (5)
occupational, and (6) spiritual. The concept of well-being is a personal experience.
DIF: Cognitive Level: Knowledge
REF: p. 263
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Health Promotion and Maintenance
3. Which of the following is an example of tertiary prevention?
a. Mammogram
b. Smoking cessation
c. Safe sex counseling
d. Diabetic meal planning class
ANS: D
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Tertiary prevention strategies focus on minimizing the damaging effects of a disease or injury
once it occurs. Preventing complications and helping people achieve their highest quality of life
regardless of their health circumstances is the goal of tertiary health promotion strategies.
Primary prevention strategies emphasize taking proactive actions that can prevent targeted
conditions. They target modifiable risk factors with health education to promote a healthy
lifestyle; for instance, promoting exercise and diet as ways to prevent obesity and diabetes. Other
examples include immunizations, low-cost flu shots, safe sex counseling, smoking cessation, use
of car seats and seat belts, motorcycle helmets, and bans on texting while driving. Advocacy for
these health protections is easily incorporated into ordinary nursing care. Secondary prevention
strategies focus on early disease detection through regular health screenings for prostate cancer,
osteoporosis, and diabetes; regular mammograms and pap smears for women; periodic
colonoscopies; and blood pressure screenings. Individuals with known risk factors such as family
history, high cholesterol, elevated blood sugar, high blood pressure, and age should be screened
periodically. Screening for mental health problems during the course of primary care visits can
detect undiagnosed depression, anxiety, and substance abuse. Early diagnosis has a direct impact
on the course and treatment of acute and chronic illness. With early case finding, the emergence
or course of a chronic disease can be modified to allow a stronger quality of life.
DIF: Cognitive Level: Comprehension
REF: p. 268
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
4. A client who is recovering from her second myocardial infarction refuses to give up smoking.
She states, “I’ve smoked so long now there’s no point quitting as the damage is done.” This
statement is best understood in the context of which of the following?
a. Social learning theory
b. Pender’s health promotion model
c. The transtheoretical model of change
d. Healthy People 2010
ANS: B
Pender’s health promotion model serves as a guide for planning successful education with
individuals and targeted high risk groups. A person’s capacity to absorb and use health promotion
information depends to a large degree on what the person believes about his or her health and the
extent to which personal actions will influence their health. In social learning theory, motivation
is a fundamental component of learning readiness. Motivation to change is a state of readiness
that fluctuates. Healthy People 2010 represents the health promotion agenda for the nation.
DIF: Cognitive Level: Application
REF: pp. 264-265
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Health Promotion and Maintenance
5. A client who has an elevation in serum cholesterol continues to eat red meat and fried foods.
Which stage of change is this client experiencing?
a. Determination
b. Action
c. Precontemplation
d. Contemplation
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ANS: C
In the precontemplation stage, a person either doesn’t see a health problem, even though it may
be obvious to others, or doesn't have any intention of modifying it in the foreseeable future.
DIF: Cognitive Level: Application
REF: p. 266
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
6. A client who overeats and is overweight is admitted to the hospital for shortness of breath. Which
of the following statements by the nurse reflects Bandura’s social theory?
a. “Your cardiac studies reveal an enlarged heart. This is a sign of cardiac problems.”
b. “I know you love to eat, but your current lifestyle is not conducive to good health.”
c. “Can you remember what it was like to get up and go to work every day? Your
buddies miss you.”
d. “If you were to lose weight, you would no longer experience shortness of breath.
Just think about how much better you would feel to breathe normally.”
ANS: D
Bandura considers learning to be a social process. He identified three sets of motivating factors
that promote the learning necessary to achieve a predetermined goal: (1) physical motivators, (2)
social incentives, and (3) cognitive motivators. “Your cardiac studies reveal an enlarged heart.
This is a sign of cardiac problems.”; “I know you love to eat, but your current lifestyle is not
conducive to good health.”; and “Can you remember what it was like to get up and go to work
every day? Your buddies miss you.” are interventions used with the transtheoretical model of
change.
DIF: Cognitive Level: Application
REF: pp. 266, 268
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
7. When caring for a client who is a newly diagnosed diabetic and who requires teaching about self-
administration of insulin, the nurse recognizes that teaching will be most effective when
a. passive involvement of the learner is encouraged.
b. there is little focus on practicing essential skills.
c. optimizing engagement in only one sense in the learning process is encouraged.
d. encouraging teach-back feedback when demonstrating new skills.
ANS: D
A highly participatory learning format, one that encourages different ways of thinking and
opportunities to try out new behaviors, is far more effective than giving simple instructions to a
client or family or demonstration without teach-back feedback. Active involvement of the learner
enhances learning. Most people learn best when they engage more than one sense in the learning
process and have an opportunity to practice essential skills.
DIF: Cognitive Level: Application
REF: p. 273
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Health Promotion and Maintenance
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8. Which of the following is the best intervention for a client who is illiterate?
a. Speak loudly and clearly.
b. Use symbols and images.
c. Personalize speech by using first name.
d. Use touch with speech.
ANS: B
Using symbols and images with which the client is familiar helps overcome the barriers of low
literacy. The client with low literacy is not necessarily hard of hearing. Personalizing speech by
using first name and using touch with speech do not help with understanding.
DIF: Cognitive Level: Application
REF: p. 279
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
9. The nurse is caring for an older adult client who is newly diagnosed with diabetes and has a low
literacy level. Which of the following guidelines for teaching low-literacy clients should the
nurse use when working with this client?
a. Teach the largest amount possible in each teaching session.
b. Sequence key behavior information last when teaching the client.
c. Use symbols and images with which the client is familiar.
d. Use words that are abstract and provide teaching in long sentences.
ANS: C
Educationally disadvantaged or functionally illiterate people are interested in learning, but nurses
need to adapt teaching situations to accommodate literacy learning differences. Marks (2009)
suggests having written materials modified to six- to eighth-grade reading levels and providing
lists of key instructions for use after visits. Using symbols and images with which the client is
familiar helps overcome the barriers of low literacy. Taking the time to understand the client's
use of words and phrases provides the nurse with concrete words and ideas that can be used as
building blocks in helping the client understand difficult health-related concepts. Otherwise, the
client may misunderstand what the nurse is saying. It is also important to check with the client
about the environmental infrastructure needed to implement self-management strategies. Don’t
assume that the client understands the implications of a clinical recommendation.
DIF: Cognitive Level: Application
REF: p. 279
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
10. When caring for clients, the nurse recognizes that which of the following statements is true
related to developmental level?
a. Developmental level affects only teaching strategies.
b. All clients are at the beginning level of the learning spectrum.
c. Developmental learning capacity is always age related.
d. Social and emotional development does not always parallel cognitive maturity.
ANS: D
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Social and emotional development does not always parallel cognitive maturity. Developmental
level affects both teaching strategies and subject content. Clients are at all levels of the learning
spectrum with regard to their social, emotional, and cognitive development. Developmental
learning capacity is not always age related.
DIF: Cognitive Level: Application
REF: pp. 280-281
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
11. A client requires teaching about a newly prescribed medication. The nurse recognizes that in
order to support the learning process of the client, the teaching process should include
a. all parties needing information.
b. only immediate family members.
c. the preferred communication style of the nurse.
d. limited cultural recognition of learning needs.
ANS: A
In many cultures, the family assumes a primary role in care of the client even when the client is
physically and emotionally capable of self-care. Including them, and especially those expected to
support the learning process of the client from the outset, in all aspects of health teaching for
health promotion is important. The culturally sensitive nurse develops knowledge of the
preferred communication style of different cultural groups and uses this knowledge in choosing
teaching strategies. Client motivation and participation increase with the use of indigenous
teachers and cultural recognition of learning needs.
DIF: Cognitive Level: Application
REF: p. 281
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
12. A client visits the wound clinic for treatment of an infected nonhealing leg ulcer. The nurse
recognizes the client is in the precontemplation stage of change. When interacting with this
client, the nurse should
a. provide the client with informational feedback to raise awareness of the health
problem and health risks involved.
b. allow open discussion related to the pros and cons of changing the client’s current
behavior.
c. assist the client in justifying a positive commitment toward making healthier
lifestyle changes.
d. assist the client in choosing the best course of action to take in resolving the
current problem.
ANS: A
In the precontemplation stage of change, a suggested approach is to raise doubt by giving
informational feedback to raise awareness of a problem and health risks.
DIF: Cognitive Level: Application
REF: p. 266
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
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13. A client has just completed an alcohol detoxification program. The client has recently
experienced the loss of his wife and has been having difficulties at work. The client has some
serious health effects from long-term alcohol abuse, including elevated serum liver enzymes. The
client states, “Alcohol is ruining my life; I will do anything to quit drinking.” The nurse should
a. ask the client what kinds of changes will be needed in order to stop drinking.
b. discuss the client’s elevated serum liver enzymes and the predictive consequences
of serious health problems, including premature death.
c. ask the client what life would be like without alcohol.
d. remind the client that he or she has been abstinent from drinking, allowing liver
tests to significantly improve.
ANS: A
The client is in the preparation stage of change, in which characteristic behaviors include the
client deciding there is a problem and the client’s willingness to make a change. A suggested
approach in this stage is to help the client choose the best course of action to take in resolving the
problem. A sample statement by the nurse includes, “What kinds of changes will you need to
make to stop drinking? Most people find Alcoholics Anonymous (AA) helpful as a support. Have
you heard of them?” In the precontemplation stage of change, the client does not think there is a
problem and is not considering the possibility of change. A suggested approach in this stage is to
raise doubt by giving informational feedback to raise awareness of a health problem and health
risks. A sample statement by the nurse includes, “Your lab tests show liver damage. These tests
can be predictive of serious health problems and premature death.” In the contemplation stage of
change, the client thinks there may be a problem, is thinking about change, and is going back and
forth between concern and unconcern. A suggested approach in this stage is to tip the balance;
allow open discussion of pros and cons of changing behavior; build motivation for change; and
help the client justify a positive commitment. A sample statement by the nurse includes, “It
sounds as though you think you may have a drinking problem, but are not sure you are an
alcoholic. What would your life be like without alcohol?” In the maintenance stage of change,
the client perseveres with positive behavioral change. A suggested approach in this stage is to
help the client identify and use strategies to sustain progress, to point out positive changes, and to
accept temporary setbacks and use steps in the determination phase, if needed. A sample
statement by the nurse includes, “It’s hard to let go of old habits, but you have been abstinent for
3 months now, and your liver tests are significantly improved.”
DIF: Cognitive Level: Application
REF: p. 266
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
14. Which of the following strategies in health education does the U.S. Preventive Services Task
Force recommend?
a. Using a standardized teaching format
b. Eliminating established behaviors
c. Offering limited information regarding the purpose of interventions
d. Suggesting small changes rather than large ones
ANS: D
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Recommendations of the U.S. Preventive Services Task Force include suggesting small changes
and baby steps rather than large ones. The task force also recommends framing the teaching to
match the client’s perceptions, linking new behaviors to old behaviors, adding new behaviors
rather than eliminating established behaviors whenever possible, and fully informing clients of
the purposes and expected outcomes of interventions and when to expect these new effects.
DIF: Cognitive Level: Knowledge
REF: p. 277
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
15. The personal values and beliefs in one’s ability to achieve health behavior changes is known as
a. social incentive.
b. self-efficacy.
c. cognitive motivator.
d. physical motivator.
ANS: B
Education and counseling for health promotion can include information on risk factors or
behaviors impacting health and ways to address negative social, economic, and environmental
determinants of health. A health promotion format considers a person’s personal values and
beliefs about his or her ability to achieve health behavior changes (self-efficacy) as part of client
assessment. Social incentive, cognitive motivator, and physical motivator are motivating factors.
DIF: Cognitive Level: Knowledge
REF: p. 266
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
16. The client states, “I have emphysema, so I have enrolled in a smoking cessation program.”
According to Prochaska’s stages of change, the client is in which of the following stages?
a. Action
b. Determination
c. Precontemplation
d. Contemplation
ANS: A
During the action stage of change, the client engages in concrete actions to effect needed change.
In the determination stage, the client decides there is a problem and is willing to make a change.
In the precontemplation stage, the client does not think there is a problem and is not considering
the possibility of change. In the contemplation stage, the client thinks there may be a problem, is
thinking about change, and goes back and forth between concern and unconcern.
DIF: Cognitive Level: Knowledge
REF: pp. 266-267
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
17. A 3-year-old child is having surgery tomorrow. A preoperative teaching strategy the nurse should
use is to
a. encourage self-directed learning.
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b. involve parents in teaching.
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c. allow child to touch and play with all equipment.
d. incorporate previous life experience.
ANS: B
Parents can provide useful information about their child’s immediate life experiences and
commonly used words to incorporate in health teaching. Encouraging self-directed learning and
incorporating previous life experience are principles of adult learning. The child should touch
and play with safe equipment.
DIF: Cognitive Level: Application
REF: pp. 280-281
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. Precede components of the Precede/Proceed Model of Health Promotion include which of the
following? (Select all that apply.)
a. Social diagnosis
b. Epidemiological diagnosis
c. Implementation
d. Outcome evaluation
e. Educational and organizational diagnosis
ANS: A, B, E
Social, epidemiological, and educational and organizational diagnoses are components of the
precede phase. Implementation and outcome evaluation are components of the proceed phase.
DIF: Cognitive Level: Knowledge
REF: pp. 274-275
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
Chapter 15: Health Teaching and Coaching
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Educational standards requiring health care agencies to provide systematic health education and
training for clients were established by
a. American Nurses Association.
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b. State Nurse Practice Acts.
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c. The Joint Commission.
d. Medicare.
ANS: C
Health teaching is not an option. It is a legal and ethical responsibility. The Joint Commission
has established educational standards requiring health care agencies to provide systematic health
education and training for clients that is specific to the client’s needs; sufficient for clients to
make informed decisions and to take responsibility for self-management activities related to their
needs; provided to clients in an understandable manner and designed to accommodate various
learning styles; and reflected in documented evidence of the client’s understanding and response
to the medical information. Professional nursing standards, developed by the American Nurses
Association (ANA), reinforce the importance of health teaching as an essential nursing
intervention. State Nurse Practice Acts mandate health teaching as an independent professional
nursing function. Medicare requirements portray health teaching as a skilled nursing intervention
for reimbursement purposes.
DIF: Cognitive Level: Knowledge
REF: p. 285
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Health Promotion and Maintenance
2. When initiating health teaching, the nurse recognizes that readiness to learn
a. is the same as the cognitive ability to learn.
b. involves a smooth and linear developmental process.
c. requires the nurse to consistently challenge the client’s learning pattern.
d. involves incorporation of the client’s learning pattern into new opportunities for
learning.
ANS: D
Rather than challenge the client’s learning pattern, the nurse needs to understand it and
incorporate it into new opportunities for learning. Readiness to learn is not the same as the
cognitive ability to learn. Nurses need to remember that learning is never smooth or linear in its
development. Rather than challenge the client’s learning pattern, the nurse needs to understand it
and incorporate it into new opportunities for learning.
DIF: Cognitive Level: Application
REF: p. 293
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
3. When the nurse formulates a goal that “the client will be able to accurately draw up the correct
dose of insulin,” the nurse recognizes this goal as referring primarily to health teaching in which
domain?
a. Changing attitudes
b. Psychomotor
c. Understanding content
d. Promoting acceptance
ANS: B
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Health teaching is a dynamic process, which involves making relevant connections to meaning
within three domains: (1) cognitive (understanding content); (2) affective (changing attitudes and
promoting acceptance); and (3) psychomotor (hands-on skill development). Changing attitudes
and promoting acceptance are in the affective domain. Understanding content occurs in the
cognitive domain.
DIF: Cognitive Level: Application
REF: pp. 286-288
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
4. The nurse is caring for a client who has a history of alcohol abuse. When formulating a goal that
“the client will be able to identify three physical effects of alcohol abuse,” the nurse recognizes
this goal as referring primarily to health teaching in which domain?
a. Cognitive
b. Affective
c. Psychomotor
d. Promoting acceptance
ANS: A
Health teaching is a dynamic process, which involves making relevant connections to meaning
within three domains: (1) cognitive (understanding content); (2) affective (changing attitudes and
promoting acceptance); and (3) psychomotor (hands-on skill development). Affective refers to
changing attitudes and promoting acceptance. Psychomotor refers to hands-on skill development.
Promoting acceptance refers to the affective domain of health teaching.
DIF: Cognitive Level: Application
REF: pp. 286-288
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
5. A theoretical foundation for the use of teaching methodologies in which a learner-centered
approach engages clients as active partners in the learning process and helps them to take
responsibility for their own learning to whatever extent possible is known as
a. Skinner’s behavioral approach.
b. Premack’s principle.
c. modeling.
d. client-centered health teaching.
ANS: D
Carl Rogers’ (1983) ideas provide a theoretical foundation for the use of teaching methodologies
in client-centered health teaching. Rogers emphasizes the primacy of the teacher-learner
relationship as the means through which learning occurs. He describes learner-centered teaching
as an interactive process. Applied to health care, a learner-centered approach involves engaging
clients as active partners in the learning process and helping them take responsibility for their
own learning to whatever extent possible. Rogers insists that the teacher must start where the
learner is, structuring the learning process to support the learner’s natural desire to learn and
being mindful of learner characteristics that enable or impede the process.
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DIF: Cognitive Level: Knowledge
REF: p. 289
TOP: Step of the Nursing Process: Implementation
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MSC: Client Needs: Health Promotion and Maintenance
6. When planning an education class for clients suffering from addiction, the nurse recognizes that
a format that encourages empowerment is an important goal of health teaching. Which of the
following is a strategy that could be viewed as disempowering?
a. Providing the client with sufficient information
b. Providing the client with emotional support
c. Placing the learner in charge of his or her learning
d. Having the nurse assume primary responsibility for the learning process
ANS: D
A highly participative learning environment, in which the nurse provides the teaching while the
learner assumes primary responsibility for the learning process, encourages empowerment.
Empowerment strategies include providing sufficient information, specific instructions, and
emotional support—but no more than is required—to allow each client to take charge of his or
her health care to whatever extent is possible. Client-centered strategies place the learner in
charge of his or her learning and build on personal strengths to achieve learning objectives.
DIF: Cognitive Level: Application
REF: p. 289
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
7. A nurse is working with a client in a drug rehabilitation center. The nurse provides positive
reinforcement each time the client demonstrates behavior that moves him closer to
accomplishing the goal of remaining drug free. The nurse recognizes this type of reinforcement
will motivate the client to engage in the desired behavior. This type of reinforcement is known as
a. empowerment.
b. chaining.
c. modeling.
d. shaping.
ANS: D
Shaping refers to the reinforcement of successive approximations of the target behavior. The
long-term goal is broken down into smaller steps. The person is reinforced for any behavior that
gets him or her closer to accomplishing the desired behavior. Rewarding specific behaviors that
move the person in the direction of the desired behavior (successive approximations) motivates
the person to engage in the desired behavior. Steps build one upon the other, moving learners
from the familiar to the unfamiliar as they progress toward meeting treatment goals.
DIF: Cognitive Level: Knowledge
REF: pp. 303-304
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
8. The concept that “the teacher must start where the learner is” was proposed by whom?
a. Skinner
b. Premack
c. Rogers
d. Taylor
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ANS: C
Rogers insists that the teacher must start where the learner is, structuring the learning process to
support the learner’s natural desire to learn and being mindful of learner characteristics that
enable or impede the process.
DIF: Cognitive Level: Knowledge
REF: p. 285
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Health Promotion and Maintenance
9. The nurse is caring for a client who is suffering from schizophrenia and cocaine abuse. The client
remains isolated in his room, refusing to attend unit activities. When implementing a behavioral
approach, what is the first step the nurse should take?
a. Define specific consequences.
b. Describe the behavior requiring change.
c. Reframe the problem as a solution statement.
d. Identify the tasks in sequential order.
ANS: B
A behavioral approach starts with a careful description and quantification of a concrete behavior
requiring change. During the third step of implementing a behavioral approach, the nurse and
client reframe the problem as a solution statement (e.g., “The client will attend all scheduled unit
activities.”). If the problem and solution are complex, the nurse can break them down into
simpler definitions, beginning with the simplest and most likely behavior to stimulate client
interest. The nurse should identify the tasks in sequential order; define specific consequences,
positive and negative, for behavioral responses; and solicit the client’s cooperation.
DIF: Cognitive Level: Application
REF: p. 303
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
10. A client is newly diagnosed with diabetes mellitus. When planning a teaching session to review
insulin administration with this client, the nurse should
a. pick times for teaching when energy levels are low.
b. schedule teaching sessions during hospital visiting hours.
c. reserve a block of time for health teaching.
d. provide the client with extensive information during 30-minute intervals.
ANS: C
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Teaching interventions should never be eliminated because the nurse lacks time, but they can be
streamlined. Even in the most limited situation, the nurse should schedule a block of time for
health teaching. The nurse should pick times for teaching when energy levels are high, the client
is not distracted by other things, it is not visiting time, and the client is not in pain. People have
saturation points as to how much they can learn in one time period. Since even under the best of
circumstances, people can absorb only so many details and fine points, the nurse should limit
information to two or three points at a time. The nurse should keep the teaching session short,
interesting, and to the point. Ideally, teaching sessions should last no longer than about 20
minutes, including time for questions. Otherwise the client may tire or lose interest. Scheduling
shorter sessions with time in between to process information helps prevent sensory overload and
reinforces teaching points.
DIF: Cognitive Level: Knowledge
REF: p. 297
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
11. Accurate documentation of client health teaching is a critical component of quality care. When
documenting in the client’s chart about health teaching for a client admitted for alcoholism, the
nurse should write
a. “Client was educated on the physical complications of alcoholism.”
b. “Client received written and verbal instructions on diet and vitamin therapy.”
c. “Client was educated on the signs and symptoms of alcohol withdrawal and when
to seek medical assistance.”
d. “Client was able to identify five triggers for relapse and was assisted to develop a
relapse prevention plan.”
ANS: D
The Joint Commission requires written documentation of all client health teaching. Notes about
the initial assessment should be succinct, but comprehensive and objective. Teaching content
should be linked to assessment data, including client preferences, previous knowledge, and
values. Included in the documentation are the teaching actions, the client response, and any
clinical issues or barriers to compliance. If family members are involved, you should identify
their role, content provided, and teaching outcomes in your documentation. Accurate
documentation helps ensure continuity and prevents duplication of teaching efforts. The client's
record informs other health care providers of what has been taught and what areas need further
work.
DIF: Cognitive Level: Application
REF: p. 300
TOP: Step of the Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
12. The nurse is teaching a support group about schizophrenia. The format includes a 20-minute
video, a didactic portion, and a discussion period. The nurse recognizes that
a. establishment of rapport with the audience is unnecessary.
b. a humorous opening grabs the audience’s attention.
c. minimal preparation is needed for this format.
d. it is important to refrain from making eye contact with the audience.
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ANS: B
An initial quote at the beginning capturing the meaning of the presentation or a humorous
opening grabs the audience’s attention. In a group presentation, the nurse will need to establish
rapport with the audience. Preparation and practice can ensure that the presentation is clear,
concise, and well spoken. The nurse should make eye contact immediately and continue to do so
throughout the presentation. Extension of eye contact to all participants communicates
acceptance and inclusion.
DIF: Cognitive Level: Application
REF: p. 305
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
13. The nurse is preparing teaching material for a class of diabetic clients. The most important aspect
when preparing a presentation with slides for group teaching is
a. the inclusion of greater than five items per slide.
b. use of large font so all participants can see from a distance.
c. use of slides as the primary content for the presentation.
d. having the presenter face the slides, not the audience.
ANS: B
Use slides to identify key points. Slides help you stay on track and move through the agenda. The
font should be large enough to see from a distance (32 point is recommended). Include no more
than four or five items per slide. Face the audience, not the slides. Practice your presentation to
ensure that you keep within the time frame and allot time for short discussion points. It is up to
you as the presenter to set the pace. No matter how interesting the presentation and dialogue that
it stimulates, running out of time is frustrating for the audience.
DIF: Cognitive Level: Application
REF: p. 305
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Health Promotion and Maintenance
14. Which of the following statements is true related to home care?
a. The nurse should consider herself a member of the family when entering the
client’s home.
b. The nurse should arrive at the client’s home unannounced to get an accurate
picture of the client’s situation.
c. Part of the teaching assessment includes appraisal of the home environment.
d. The nurse should wash her hands in the kitchen sink when visiting the client.
ANS: C
In home care the nurse is a guest in the client’s home. Part of the teaching assessment includes
appraisal of the home environment, family supports, and resources, as well as client needs. The
nurse should always call before going to the client’s home. This is a common courtesy; it also
protects the nurse’s time if the client is going to be out. When in the home, it is important to
model appropriate behaviors (e.g., washing hands in the bathroom sink before touching the
client). Simple strategies, like not washing one’s hands in the kitchen sink where food is
prepared, encourage the client to do likewise.
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DIF:
Cognitive Level: Knowledge
REF: p. 305
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TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
15. An older adult client is hospitalized after a fall. The client states, “I want to return home because
I like to be independent.” The nurse notes that the client lives alone and will be required to attend
physical therapy three times a week. Which of the following nursing diagnoses is appropriate for
this client?
a. Anxiety
b. Ineffective coping
c. Self-care deficit
d. Impaired home maintenance
ANS: C
The client lives alone and requires physical therapy related to a fall. The client will require
assistance with care. There is insufficient evidence to diagnose anxiety. The client states that he
is independent, which indicates coping skills, and there is no evidence of impairment in home
maintenance.
DIF: Cognitive Level: Application
REF: p. 306
TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
16. Which of the following is an effective teaching objective? The client will be able to
a. ambulate short distances around the nursing unit.
b. learn subcutaneous self-administration of insulin.
c. understand diabetes and its lifestyle implications.
d. perform foot care correctly after three teaching sessions.
ANS: D
Objectives are powerful guides to organizing content and suggesting appropriate planning
activities. Each objective should describe an immediate action step that the client should take to
accomplish relevant treatment outcomes. Teaching objectives should be modest and achievable
in the time frame allotted. They should be logically organized and build on one another for
maximum effectiveness. To determine whether an objective is achievable, the nurse should
consider the client’s level of experience, educational level, resources, and motivation; then the
nurse should define each learning objective needed to achieve the health goal in specific,
measurable behavioral terms. Ambulating short distances is not specific enough or measurable.
Learning subcutaneous self-administration of insulin is not specific. Understanding diabetes and
its lifestyle implications is not measurable.
DIF: Cognitive Level: Comprehension
REF: p. 290
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
17. A client requires health teaching for exercises related to an arthritic shoulder. During an
assessment, the client tells the nurse she is a kinetic learner. What teaching resource should the
nurse recommend to this client?
a. Reading a book about arthritis
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b. Watching an exercise video
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c. Performing water aerobics
d. Listening to an exercise audiotape
ANS: C
The kinetic learner learns best with hands-on involvement. The visual learner would use books
and videos. An exercise audiotape would benefit the auditory learner.
DIF: Cognitive Level: Application
REF: p. 292
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. When assessing teaching and learning needs at discharge, the nurse should focus on which of the
following? (Select all that apply.)
a. What potential problems are likely to prevent a safe discharge
b. The client’s ability to pay for his or her hospitalization
c. What potential problems are likely to cause complications or readmission
d. What prior knowledge or experience the client and family has with the current
problem
e. What skills and equipment are needed to manage the problem at home
f. Who or what agency will assume responsibility for continuing care
ANS: A, C, D, E, F
Assessing teaching and learning needs at discharge includes asking the following questions:
What potential problems are likely to prevent a safe discharge? What potential problems are
likely to cause complications or readmission? What prior knowledge or experience does the
client and family have with this problem? What skills and equipment are needed to manage the
problem at home? Who (what agency) will assume responsibility for continuing care? The
client’s ability to pay for hospitalization should not be a focus of teaching and learning needs at
discharge. If the client has concerns about ability to pay for hospitalization, the nurse can ask a
case manager to visit with the client.
DIF: Cognitive Level: Comprehension
REF: pp. 291-295
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
Chapter 16: Empowerment-Oriented Communication Strategies to Reduce Stress
Arnold: Interpersonal Relationships, 7th Edition
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MULTIPLE CHOICE
1. Current research suggests that men and women respond to stress in which of the following ways?
a. Men use nurturing activities to reduce stress.
b. Women use a “tend and befriend” approach to stress.
c. Men and women respond to stress in a similar manner.
d. Women respond to stress with patterns of “fight or flight.”
ANS: B
Current research suggests that men and women respond to stress differently. Men respond with
patterns of “fight or flight” while women use a “tend and befriend” approach. Women use
nurturing activities to reduce stress and promote safety for self and others. They seek social
support from others, particularly from other women.
DIF: Cognitive Level: Knowledge
REF: p. 311
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. Which of the following is true in relation to stress?
a. Men and women respond to stress in the same fashion.
b. Culture does not affect the stress experience.
c. Stress is always a negative experience.
d. Stress can have protective and adaptive functions.
ANS: D
Hans Selye used the term eustress to describe a short-term mild level of stress. It acts as a
positive stress response with protective and adaptive functions and is perceived as being within
the person’s ability to manage. Current research suggests that men and women respond to stress
differently. The nurse should pay attention to cultural values. What is a small stressor in one
culture can be huge in another, and normal coping strategies can be quite different. Stress results
from positive as well as negative forces, for example, a job promotion, impending wedding, or
birth of a child.
DIF: Cognitive Level: Knowledge
REF: p. 310
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. The nurse is conducting a family assessment in which alcoholism by the parents is suspected.
When assessing the children within this family for symptoms of stress, the nurse recognizes that
a. the children will most likely verbalize their feelings about the stressor.
b. the children will demonstrate the ability to sort out the meaning of the illness.
c. signs of distress can include academic decline, gastric distress, and headaches.
d. physical complaints by the children can only be related to a physiological etiology.
ANS: C
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Signs of distress such as academic decline, gastric distress, and headaches can alert the nurse to
unvoiced stress. Children express stress through behavior. Health disruptions create special
problems for children because they lack the words and life experience to sort out the meaning of
illness, either their own or that of a significant family member.
DIF: Cognitive Level: Application
REF: p. 320
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
4. A short-term mild level of stress that acts as a positive stress response with protective and
adaptive functions and is perceived as being within the person’s ability to manage is known as
a. stress.
b. eustress.
c. stressor.
d. distress.
ANS: B
Hans Selye used the term eustress to describe a short-term mild level of stress. It acts as a
positive stress response with protective and adaptive functions and is perceived as being within
the person’s ability to manage. Stress represents a natural physiologic, psychological, and
spiritual response to the presence of a stressor. A stressor is defined as a demand, situation,
internal stimulus, or circumstance that threatens a person’s personal security or self-integrity.
Distress is defined as a negative stress that causes a higher level of anxiety and is perceived as
exceeding the person’s coping abilities. It is experienced as being unpleasant and diminishes
performance.
DIF: Cognitive Level: Application
REF: p. 310
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. A three-stage progressive pattern of nonspecific physiologic responses known as alarm,
resistance, and exhaustion is based on
a. Cannon’s scientific physiologic response theory.
b. Selye’s General Adaptation Syndrome.
c. Holmes and Rahe’s stimuli stress model.
d. Lazarus and Folkman’s transactional model of stress.
ANS: B
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Hans Selye’s General Adaptation Syndrome describes responses to longer-term stress exposure.
Selye described a three-stage progressive pattern of nonspecific physiologic responses, which he
branded as alarm, resistance, and exhaustion. Walter Cannon was the first to describe a scientific
physiological basis for an acute stress response. Cannon believed that when people feel
physically well, emotionally centered, and personally secure, they are in a state of dynamic
equilibrium or homeostasis. Stress disturbs homeostasis. Thomas Holmes and Richard Rahe
developed a stress model that considered stressful life events such as marriage, divorce, death,
and losing a job as stimuli that threaten or disrupt homeostasis. Lazarus and Folkman’s
transactional model of stress is one of the most widely used to explain stress responses. It is
based on the premise of a dynamic relationship between a situation or circumstance in the
environment (stressor) and the individual experiencing the stressor that accounts for its impact
on a person.
DIF: Cognitive Level: Knowledge
REF: p. 311
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
6. A client is experiencing anxiety related to hospitalization. When assessing this client, the nurse
anticipates which assessment finding?
a. Increased socialization
b. Improved sleep
c. Greater recall ability
d. Disengagement from the stressor
ANS: D
Stress doesn’t always look like a “stressor response.” Some people internalize stress. They
withdraw or seem disengaged from an obvious stressor, when stressed.
DIF: Cognitive Level: Analysis
REF: p. 318
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
7. A client’s spouse becomes anxious and demonstrates hostility toward the nurse. The best
response by the nurse is to
a. recognize the spouse feels a sense of control.
b. view the hostility as a personal attack.
c. become stoic and refrain from listening to the spouse.
d. respond empathetically to contributory themes and feelings.
ANS: D
What a hostile anxious client or family needs most at that moment—despite their behavior—is
understanding, comforting, and human caring. The nurse should listen, ask, and respond
empathetically to contributory themes and feelings. Anger and hostility are the most common
stress emotions associated with feeling helpless or psychologically threatened. Recognizing
hostility as a cry for help in coping with escalating stress makes it easier to respond
empathetically. Most outbursts have little to do with the nurse personally other than that the
nurse is available, is the one most involved with the care of the loved one, and is least likely to
retaliate.
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DIF: Cognitive Level: Application
REF: pp. 317-318
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
8. A client tells the nurse, “I think I’m losing my mind.” The best response by the nurse is
a. “Tell me what you are experiencing right now.”
b. “You should take a nap now; it will help you to feel better.”
c. “If you say that you’re losing mind, you really will lose your mind.”
d. “I don’t think you really feel that you are losing your mind.”
ANS: A
The nurse should listen carefully and ask gentle, probing questions. A helpful statement can
include, “Can you tell me what you are experiencing right now?” This listening response allows
the client to put concerns into words. The nurse should allow clients to be in charge of areas and
issues that are not at odds with a treatment protocol, and helping clients discover the real causes
of their frustration can reduce stress through direct action. Clients experiencing stress should be
given the opportunity to express their feelings, thoughts, and worries. Crying, anger, and magical
thinking are normal reactions to situations that one cannot control. Acknowledging the
legitimacy of feelings as a normal response to an abnormal situation reinforces the client’s selfintegrity and helps the client put boundaries on their anxiety.
DIF: Cognitive Level: Application
REF: p. 321
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
9. A client who has been diagnosed with cancer asks the nurse, “If I take the chemotherapy, will I
be cured, or am I going to die anyway?” The nurse’s best response is
a. “Tell me what prompted your question.”
b. “I don’t think you should have chemotherapy; it will harm you more than help
you.”
c. “Let’s not talk about dying; I’m sure you will be cured.”
d. “I really don’t think you should worry about such things; it isn’t something you
can control.”
ANS: A
It is difficult to directly answer stress-related questions about uncertainties, like, “If I take the
chemotherapy, will I be cured, or am I going to die anyway?” The reality is that there may be no
single answer. It helps to ask the client what prompted the question and to have a good idea of
the client’s level of knowledge before answering. Allowing clients to be in charge of areas and
issues that are not at odds with a treatment protocol and helping clients discover the real causes
of their frustration can reduce stress through direct action. Clients experiencing stress should be
given the opportunity to express their feelings, thoughts, and worries.
DIF: Cognitive Level: Analysis
REF: p. 323
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
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10. A nurse consistently works extra shifts in the hope of earning a promotion. The nurse is
becoming increasingly fatigued and frustrated because the promotion has not occurred. The nurse
is experiencing
a. distress.
b. burnout.
c. eustress.
d. primary appraisal.
ANS: B
Burnout is defined as “a state of fatigue or frustration brought about by devotion to a cause, way
of life, or relationship that failed to produce an expected reward.” It develops in individuals
involved with “people work” and is characterized by emotional exhaustion, depersonalization,
and a sense of diminished professional accomplishment. Distress is defined as a negative stress
that causes a higher level of anxiety and is perceived as exceeding the person’s coping abilities.
It is experienced as being unpleasant and diminishes performance. Hans Selye used the term
eustress to describe a short-term mild level of stress. It acts as a positive stress response with
protective and adaptive functions and is perceived as being within the person’s ability to manage.
Primary appraisal focuses on the stressor or stressful event itself—its content and strength as a
personal threat.
DIF: Cognitive Level: Application
REF: pp. 326-328
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
11. The nurse is caring for a client who works as a boxer. The client states, “I was picked on a lot
when I was little, so I got really angry and now I work through the anger by boxing.” The nurse
recognizes the client is demonstrating which ego defense mechanism?
a. Denial
b. Intellectualization
c. Sublimation
d. Repression
ANS: C
Sublimation is redirecting socially unacceptable unconscious thoughts and feelings into socially
approved outlets. Sublimation is used to channel extreme anger impulses into acceptable
behaviors—for example by becoming a butcher or boxer. Denial is the unconscious refusal to
allow painful facts, feelings, or perceptions into awareness. Intellectualization is the unconscious
focusing on only the intellectual and not the emotional aspects of a situation or circumstance.
Repression is unconscious forgetting of parts or all of an experience.
DIF: Cognitive Level: Application
REF: p. 315
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
12. Which of the following interventions would be classified as secondary prevention for stress?
a. Classify stressor
b. Mobilize resources
c. Educate client and family
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d. Coordinate resources
ANS: B
Mobilizing resources is classified as a secondary prevention intervention. A primary intervention
is to classify the stressor. Educating client and family is a primary intervention. Coordinating
resources is a tertiary intervention.
DIF: Cognitive Level: Knowledge
REF: p. 318
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
Chapter 17: Communicating with Clients Experiencing Communication Deficits
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following is true in relation to communication deficits?
a. Communication deficits occur only as a result of physical disabilities.
b. Communication deficits can arise from sensory deprivation.
c. Individuals who are equally impaired are equally disabled.
d. The primary nursing goal is to minimize the client’s independence.
ANS: B
Communication deficits can arise from the kind of sensory deprivation that occurs in some
agencies and units such as intensive care units. A communication disability definition includes
any client who has any impairment in body structure or function that interferes with
communication. Specifically, the client has a communication difficulty due to impaired
functioning of one or more of his five senses or he has impaired cognitive processing
functioning. Communication deficits can arise from the kind of sensory deprivation that occurs
in some agencies and units such as intensive care units. Two individuals can have the same
sensory impairment but not be equally communication disabled. Each person compensates for
their impairment in different ways. The primary nursing goal is to maximize the client’s ability to
successfully interact with the health care system.
DIF: Cognitive Level: Knowledge
REF: p. 334
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. The nurse is caring for an older adult client who has recently withdrawn from relationships,
appears depressed, and appears reluctant to seek information from the nurse. The nurse suspects
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the client is experiencing hearing loss. The nurse recognizes that
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a.
b.
c.
d.
the client will readily acknowledge that this is the problem if asked.
the client may try to hide deficits and withdraw from relationships.
decreased hearing ability is not related to conversational style.
older adults, as a group, have better consonant discrimination.
ANS: B
Deprived of a primary means of receiving signals from the environment, clients with hearing loss
may try to hide deficits, may withdraw from relationships, become depressed, or be less likely to
seek information from health care providers.
DIF: Cognitive Level: Application
REF: p. 335
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
3. The nurse is caring for a client who has experienced a stroke. The client has aphasia. The nurse
recognizes that aphasia is a
a. neurological linguistic deficit.
b. cognitive comprehension deficit.
c. sensory deprivation deficit.
d. mental disorder deficit.
ANS: A
Aphasia is defined as a neurological linguistic deficit. There may be no cognitive, sensory, or
mental impairment. While there may be no cognitive impairment, the client may need more
“think time” for cognitive processing during a conversation.
DIF: Cognitive Level: Application
REF: p. 335
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
4. When communicating with a client diagnosed with a serious mental disorder, it is important for
the nurse to recognize which of the following?
a. Clients with mental disorders never have intact sensory channels
b. Clients with a ‘flat affect’ are easier to understand
c. Clients with mental disorders are always very talkative
d. Clients with mental disorders may suffer from social isolation and impaired coping
ANS: D
Clients with serious mental disorders may have a different type of communication deficit
resulting from a malfunctioning of the neurotransmitters that normally transmit and make sense
out of messages in the brain. Social isolation and impaired coping may accompany the client’s
inability to receive or express language signals. Other communication problems occur with
different mental disorders. As an example, some clients with mental disorders can perhaps have
intact sensory channels, but they cannot process and respond appropriately to what they hear,
see, smell, or touch. The nurse may notice a lack of vocal inflection and an unchanging facial
expression. A ‘flat affect’ makes it difficult to truly understand the client. Some clients with
mental disorders present with a poverty of speech and limited content. Speech appears blocked;
reflecting disturbed patterns of perception, thought, emotions, and motivation.
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DIF: Cognitive Level: Application
REF: p. 336
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. When caring for a hearing-impaired client, the nurse should
a. face the interpreter when speaking to the client.
b. use gestures that reinforce verbal content.
c. speak distinctly while exaggerating words.
d. communicate in a dimly-lit room.
ANS: B
For hearing-impaired clients, the nurse should use facial expressions and gestures that reinforce
verbal content. The nurse should always face the client when communicating, so the client can
see the nurse’s lips move. The nurse should speak distinctly without exaggerating words.
Partially deaf clients respond best to well-articulated words spoken in a moderate, even tone. The
nurse should stand or sit to face the client and allow the client to see facial expressions and
mouthing of words. The nurse should also communicate in a well-lighted room.
DIF: Cognitive Level: Knowledge
REF: p. 338
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
6. When caring for the client with macular degeneration, the nurse should
a. face the client directly.
b. stand to the client’s side.
c. hold the client’s arm when walking.
d. refrain from touching the client.
ANS: B
When caring for clients with macular degeneration, the nurse should remember to stand to their
side, an exception to the “face them directly” rule applied with hearing loss clients. Macular
degeneration clients often still have some peripheral vision. For vision-impaired clients, the
nurse should not lead or hold the client’s arm when walking; instead, the nurse should allow the
person to take her arm. The nurse should use touch and close physical proximity while with the
client, and the nurse should give the client something substantial to touch when leaving the
client.
DIF: Cognitive Level: Application
REF: p. 340
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
7. Which of the following clients with a communication deficit requires the use of touch during a
therapeutic encounter?
a. Vision-impaired client
b. Client with a hearing loss
c. Mentally ill client
d. Client with schizophrenia
ANS: A
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The social isolation experienced by blind clients can be profound, and the need for human
contact is important. Touching the client lightly as the nurse speaks alerts the client to the nurse’s
presence. For vision-impaired clients, the nurse should let the person know when approaching by
a simple touch, and always indicate when leaving. The nurse should use touch and close physical
proximity while with the client, and give the client something substantial to touch when leaving
the client. The nurse should tap on the floor or table to get the client’s attention via vibration.
Other communication problems occur with different mental disorders. As an example, some
clients with mental disorders can have intact sensory channels, but they cannot process and
respond appropriately to what they hear, see, smell, or touch. In some forms of schizophrenia,
there are alterations in the biochemical neurotransmitters in the brain that normally conduct
messages between nerve cells and help orchestrate the person’s response to the external
environment. Messages have distorted meanings.
DIF: Cognitive Level: Knowledge
REF: p. 340
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
8. The nurse is caring for an older adult client who is recovering from a stroke. When the nurse
speaks to the client, the client nods her head and responds using incoherent words. Which type of
aphasia does this client exhibit?
a. Expressive
b. Receptive
c. Global
d. Cognitive
ANS: A
The client with expressive aphasia can understand what is being said but cannot express thoughts
or feelings in words. Receptive aphasia creates difficulties in receiving and processing written
and oral messages. With global aphasia, the client has difficulty with both expressive language
and reception of messages. A client may have feelings of loss and social isolation imposed by the
communication impairment. While there may be no cognitive impairment, the client may need
more “think time” for cognitive processing during a conversation.
DIF: Cognitive Level: Application
REF: p. 341
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
9. The nurse is caring for a client who has experienced global aphasia secondary to a stroke. Which
of the following interventions is most appropriate for this client?
a. Refrain from exploiting any language skills that are preserved
b. Frequently remind the client they cannot be understood
c. Encourage short, positive sessions to communicate
d. Spend long periods of time talking with the client to provide stimulation
ANS: C
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Clients who lose both expressive and receptive communication abilities have global aphasia.
These clients can become frustrated when they are not understood. Struggling to speak causes
fatigue. Short, positive sessions are used to communicate. Otherwise, the client may become
nonverbal as a way of regaining energy and composure. Any language skills that are preserved
should be exploited.
DIF: Cognitive Level: Analysis
REF: p. 341
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
10. The nurse is caring for an unconscious client. The client’s family member reports that a nurse at
the client’s bedside stated, “I wouldn’t want to live in this condition.” What did this nurse not
realize about the client’s capabilities?
a. The client can read lips
b. Hearing can remain acute in clients who are not fully alert
c. The client can respond to statements through written communication
d. The client can be sensitive to the nurse’s nonverbal behavior
ANS: B
When a client is not fully alert, it is not uncommon for nurses to speak in their presence in ways
they would not if they thought the client could fully understand what is being said, forgetting that
hearing can remain acute. Good clinical practice suggests never saying anything the nurse would
not want the client to hear. The ability to read lips, respond to written communication, or be
sensitive to nonverbal behavior does not relate to the verbal statement made by the nurse.
DIF: Cognitive Level: Application
REF: p. 342
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
11. The nurse is caring for a client who is nonverbal. When caring for this client, the nurse should
a. insist the client communicate in a two-way mode.
b. continue to initiate communication in a one-way mode.
c. refrain from explaining procedures because the client will not understand.
d. limit orienting cues in order to reduce environmental stimuli.
ANS: B
When clients are unable or unwilling to engage in a dialogue, the nurse should continue to
initiate communication in a one-way mode. Giving orienting cues is recommended, such as
labeling of meals as breakfast, lunch, or dinner; and linking events to routines (e.g., saying, “The
x-ray technician will take your chest x-ray right after lunch”) helps secure the client in time and
space.
DIF: Cognitive Level: Application
REF: p. 343
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
12. When attempting to communicate a procedure to a Spanish-speaking client, a strategy that the
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nurse could use to facilitate understanding would be
a. speak distinctly while exaggerating words.
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b. attempt to use sign language.
c. use pictographs.
d. explain what is happening in complex terms.
ANS: C
Pictographs are one of many tools recommended for communicating within nursing. For hearingimpaired clients, the nurse should speak distinctly without exaggerating words. There is no
mention in the question of this client being hearing-impaired. American Sign Language has been
a standard communication tool for many years; however, few care providers were able to use it.
Even when a client appears not to understand, the nurse should explain in very simple terms
what is happening.
DIF: Cognitive Level: Application
REF: p. 338
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
13. The nurse is caring for a client who is hearing-impaired and legally blind in his right eye. The
client has just returned from cataract surgery on his left eye. The nurse recognizes that
a. the client’s arm should be held when walking.
b. verbal speech is useless in this situation.
c. signals should be developed to indicate changes in pace or direction while walking.
d. the client should be discouraged from reading lips.
ANS: C
For vision-impaired clients, the nurse should develop and use signals to indicate changes in pace
or direction while walking. The nurse should not lead or hold the client’s arm when walking, but
instead allow the client to take the nurse’s arm. The nurse should speak distinctly without
exaggerating words. Partially deaf clients respond best to well-articulated words spoken in a
moderate, even tone. The client with hearing loss should be encouraged to verbalize speech, even
if they only use a few words or the words are difficult to understand at first. The nurse should
always face the client when communicating so the client can see the nurse’s lips move.
DIF: Cognitive Level: Application
REF: p. 338
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
14. The nurse understands that as clients age, they are more likely to have vision problems that may
interfere with the communication process, including the lens of the eyes becoming less flexible,
making it difficult to accommodate shifts from far to near vision. The nurse recognizes that this
condition is known as
a. receptive aphasia.
b. autism.
c. presbycusis.
d. presbyopia.
ANS: D
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As clients age, they are more likely to have vision problems that may interfere with the
communication process because the lens of the eyes become less flexible, making it difficult to
accommodate shifts from far to near vision. This is a condition known as presbyopia. Receptive
aphasia creates difficulties in receiving and processing written and oral messages. Atypical
communication is often the first behavioral clue to cognitive impairment in young children,
associated with conditions such as mental retardation, autism, and affective disorders.
Presbycusis, or degeneration of ear structures, is a sensorineural dysfunction that normally
occurs as one ages.
DIF: Cognitive Level: Application
REF: p. 335
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
Chapter 18: Communicating with Children
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. In mastering QSEN competency of patient-centered care, effective tools need to be
a. cognitive, developmentally appropriate, and educational.
b. cultural, educational, interpersonal, and societal.
c. attitudinal, cognitive, and developmentally appropriate.
d. attitudinal, cultural, and developmentally appropriate.
ANS: C
In mastering QSEN competency of patient-centered care, effective tools need be attitudinal,
cognitive, and developmentally appropriate.
DIF: Cognitive Level: Knowledge
REF: p. 345
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. When caring for a preschooler, the nurse understands that this child tends to interpret language in
a literal way and that the child will not ask for clarification, leading to a misunderstanding of
messages. The nurse recognizes a preschooler is in which of Piaget’s cognitive stages of
development?
a. Concrete operations
b. Formal operations
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c. Preoperational
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d. Sensorimotor
ANS: C
Throughout the preoperational period, young children tend to interpret language in a literal way.
For example, the child who is told that he will be “put to sleep” during the operation tomorrow
may think it means the same as the action recently taken for a pet dog who was too ill to live.
Children do not ask for clarification, so messages can be misunderstood quite easily. The
concrete operations stage occurs from approximately 7 to 11 years of age. The formal operations
stage starts at about age 12+ years. The sensorimotor stage is from birth to about 2 years of age.
DIF: Cognitive Level: Application
REF: p. 347|p. 353
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Health Promotion and Maintenance
3. When communicating with a preschooler who is admitted to the hospital for a fractured arm,
which is the best method for the nurse to describe the preschooler’s impending surgery?
a. Encourage the preschooler to put a bandage on a teddy bear’s arm.
b. Explain what surgery will be like, using abstract terminology.
c. Explain to the preschooler how long the surgery will take and that it will be done
by noon.
d. Inform the preschooler that fixing the fractured arm will make it possible to play
sports in the future.
ANS: A
Preschoolers tend to think of their illness, their separation from parents, and any painful
treatments as punishment. Play can be used to help children express their feelings about an
illness and to role play coping strategies. Allowing the young child to manipulate syringes and
give “shots” to a doll or put a bandage or restraint on a teddy bear’s arm gives the child a chance
to act out his feelings. The child becomes “the aggressor.” Play can be a major channel for
communication in the nurse-client relationship involving a young child. Preschool children
develop communication themes through their play and work through conflict situations in their
own good time; the process cannot be rushed. When working with a school-age child, the nurse
should search for concrete examples to which the child can relate rather than giving abstract
examples. Abstract thinking occurs in the formal operations stage. Children who are 7-11 years
of age are in Piaget’s concrete operations stage, in which they master the use of numbers and
other concrete ideas such as classification and conservation. Children who are 12+ years of age
are in Piaget’s formal operations stage, in which they tend to think about the future.
DIF: Cognitive Level: Analysis
REF: p. 354
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
4. When assessing a child’s reaction to illness, it is important for the nurse to
a. observe the interaction between parent and child.
b. recognize that chronological age matches cognitive level.
c. realize that children are more comfortable with female health care providers.
d. recognize that the child’s behavior will be age appropriate.
ANS: A
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Assessing a child’s reaction to illness requires knowing the child’s normal patterns of
communication. Interactions are observed between parent and child. Variations occur across
situations, so that the child under stress or in a different environment may process information at
a lower level than he would under normal conditions. Because two children of the same
chronological age may have quite different skills as information processors, the nurse needs to
assess level of functioning. Some studies show school-age children are more satisfied if their
health care provider is the same gender. A severe illness can cause a child to show behaviors that
are reminiscent of an earlier stage of development. A certain amount of regression is normal.
DIF: Cognitive Level: Application
REF: p. 348
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
5. The nurse is caring for a child with a severe illness who is demonstrating behaviors that are
reminiscent of an earlier stage of development. When the child has toileting accidents, the nurse
should
a. recommend a urology consult.
b. obtain a urine sample and send it to the lab.
c. reassure the child’s parents that this is common.
d. eliminate all fluids after dinner.
ANS: C
A severe illness can cause a child to show behaviors that are reminiscent of an earlier stage of
development. A certain amount of regression is normal. Common behaviors include whining,
demanding undue attention, withdrawal, or having toileting “accidents.” These behaviors might
stem from the powerlessness the child feels in attempting to cope with an overwhelming,
frightening environment. Reassuring the parents that this is a common response to the stress of
illness can be helpful and is the best approach.
DIF: Cognitive Level: Analysis
REF: pp. 348-349
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
6. A pediatric nurse is educating parents about how children cope with hospitalization. Which of the
following statements by the nurse is correct?
a. “The quiet, compliant child who never complains is comfortable on the nursing
unit.”
b. “The child who screams and cries is much more frightened of hospitalization than
the quiet child.”
c. “The 2-year-old child who asks for a bedtime bottle is showing signs of
regression.”
d. “The child who screams and cries may be less frightened than the quiet, overly
compliant child who never complains.”
ANS: D
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Because children have limited life experience to draw from, they exhibit a narrower range of
behaviors in coping with threat. The quiet, overly compliant child who does not complain may be
more frightened than the child who screams or cries. The nurse needs to obtain detailed
information regarding the usual behavioral responses of the family and child. Some behaviors
that look regressive may be a typical behavioral response for the child (e.g., the 2-year-old who
wants a bedtime bottle).
DIF: Cognitive Level: Application
REF: p. 348
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
7. When communicating with hospitalized infants and toddlers, the nurse knows
a. she should use long sentences with soothing words.
b. she cannot communicate with a preverbal infant.
c. moving to the child’s eye level and maintaining eye contact are important.
d. she should pick up an 18-month-old infant immediately.
ANS: C
Face-to-face position, bending or moving to the child’s eye level, maintaining eye contact, and
making a reassuring facial expression help in interactions with infants. To help the child’s
comprehension, the nurse should use phrases rather than long sentences and repeat words for
emphasis. Cues to assessment of the preverbal infant include tone of the cry, facial appearance,
and body movements. Because the infant uses the senses to receive information, nonverbal
communication (e.g., touch) is an important tool for the pediatric nurse. Tone of voice, rocking
motion, use of distraction, and a soothing touch can be used in addition to or in conjunction with
verbal explanations. The nurse should anticipate developmental behaviors such as “stranger
anxiety” in infants between 9 and 18 months of age. Rather than reaching to pick a child up
immediately, the nurse might smile and extend a hand toward the child or stroke the child’s arm
before attempting to hold the child. In this way, the nurse acknowledges the infant’s inability to
generalize to unfamiliar caregivers.
DIF: Cognitive Level: Comprehension
REF: p. 350
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
8. During the preoperational period the nurse recognizes that children
a. ask numerous questions to clarify a message.
b. can process auditory information quickly.
c. can clearly distinguish between fantasy and reality.
d. misunderstand messages quite easily.
ANS: D
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Throughout the preoperational period, young children tend to interpret language in a literal way.
For example, the child who is told that he will be “put to sleep” during the operation tomorrow
may think it means the same as the action recently taken for a pet dog who was too ill to live.
Children in the preoperational stage do not ask for clarification, so messages can be
misunderstood quite easily. Preschool children have limited auditory recall and are unable to
process auditory information quickly. Before the age of 7 years, most children cannot make a
clear distinction between fantasy and reality. Everything is “real,” and anything strange is
perceived as potentially harmful.
DIF: Cognitive Level: Comprehension
REF: p. 353
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
9. The nurse is caring for a postoperative preschooler who is crying and has been refusing to eat.
The best communication strategy for the nurse to use is to
a. avoid providing the child with simple explanations.
b. assign the child to a different nurse in order to optimize socialization.
c. give the child some clay, crayons, and paper.
d. encourage the child to express complex thoughts and feelings.
ANS: C
Play materials vary with the age and developmental status of the child. Simple, large toys are
used with young children; more intricate playthings are used with older preschoolers. Clay,
crayons, and paper become modes of expression for important feelings and thoughts about
problems. Play can be the nurse’s primary tool for assessing preschool children’s perceptions
about their hospital experience, their anxieties, and their fears. Play can increase their coping
ability. Simple explanations reduce the child’s anxiety. No child should ever be left to figure out
what is happening without some type of simple explanation. Assigning the same caregiver
reduces insecurity. The preschooler lacks a suitable vocabulary to express complex thoughts and
feelings.
DIF: Cognitive Level: Application
REF: p. 354
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
10. Which of the following is true in relation to the stress of having an ill child?
a. Coping with uncertainty over the outcome is the most stressful factor for parents.
b. Factors connected with the child’s illness causes more stress than alleviation of the
child’s pain.
c. Uncertainty about a critically ill child’s current condition is considered to be a
minor source of stress.
d. The parents’ inability to comfort the child is more stressful than factors connected
with the illness.
ANS: D
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Having an ill child is stressful for parents. Many research studies have shown that loss of the
ability to act as the child’s parent, to alleviate the child’s pain, and to comfort the child is more
stressful than factors connected with the illness, including coping with uncertainty over the
outcome. Major sources of stress for parents of critically ill children include uncertainty about
current condition or prognosis, lack of control, and lack of knowledge about how to best help
their hospitalized child or how to deal with their child’s response.
DIF: Cognitive Level: Knowledge
REF: p. 360
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
11. When admitting an adolescent to a hospital unit, the nurse knows she should keep in mind which
of the following?
a. The nurse should use the “three wishes” question to assess cognitive level.
b. When a teen asks a direct question, the teen does not really want the answer.
c. Teens recognize that life is a roller-coaster ride with ups and downs.
d. Teens are able to self-assess competency.
ANS: A
To assess a teen’s cognitive level and to find out about the ability to make long-term plans, an
easy approach is to use the “three wishes” question. The nurse should ask the teen to name three
things he would expect to have in 5 years. Answers can be analyzed for factors such as
concreteness, realism, and goal-directness. When a teen asks a direct question, he is ready to hear
the answer. The nurse should answer directly and honestly. Some teens lack sufficient experience
to recognize that life has ups and downs and that things will eventually be better. Adolescents
still rely primarily on feedback from adults and from friends to judge their own competency.
DIF: Cognitive Level: Application
REF: p. 357
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
12. The pediatric nurse is working on an oncology unit with a terminally ill child. The nurse conveys
respect to the child by
a. interacting as a buddy to the child.
b. protecting the child from the truth about the terminal illness.
c. using the concept of mutuality.
d. being emotionally unavailable.
ANS: C
When interacting with the older child, using the concept of mutuality will promote respect and
should foster more positive and lasting health care outcomes. Being authentic does not mean
being overly familiar. Trying to interact with older children and adolescents as though the nurse
is a buddy is confusing to the client. What the child wants is an emotionally available, calm,
caring, competent resource that can protect, care about, and above all, listen to him or her.
Providing truthful answers is a hallmark of respect.
DIF: Cognitive Level: Application
REF: p. 360
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Psychosocial Integrity
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13. The nurse is caring for a 2-year-old child on a pediatric unit. The child’s parents have just left the
unit for the night. The child is standing at the edge of the crib and crying. Which of the following
interventions is most appropriate for the nurse to use?
a. Limit the use of kinesthetic approaches when caring for the child.
b. Talk to the child about Mommy and Daddy and how much the child cares for them.
c. Maintain a flat affect when interacting with the child.
d. At first maintain a distance of 8 feet from the child.
ANS: B
Handling separation anxiety when the primary caregiver is absent includes establishing rapport
with the caregiver (parent) and encouraging them to be with the child and reassuring the child
that staff will be there if they are away. At first the nurse should keep at least 2 feet between
herself and the infant. The nurse should talk to and touch the infant and initially smile often. The
nurse should provide for kinesthetic approaches; offer self while infant is protesting (e.g., stay
with the child; pick the child up and rock or walk; talk to the child about Mommy and Daddy and
how much the child cares for them).
DIF: Cognitive Level: Analysis
REF: p. 351
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
14. The nurse recognizes that guidelines for developing a workable limit-setting plan include having
consequences that are
a. applied after a detailed verbal exchange with the client.
b. person centered, not situation centered.
c. applied in a matter-of-fact manner, without lengthy discussion.
d. applied at a time negotiated between the nurse and client.
ANS: C
Guidelines for developing a workable limit-setting plan include having consequences that are
applied in a matter-of-fact manner, without lengthy discussion, are logical and fit the situation,
and occur immediately following the transgression.
DIF: Cognitive Level: Knowledge
REF: p. 359
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
15. A school-aged child is admitted to the hospital because of an accident during gymnastics. The
child complains of not feeling her legs. The child’s parents ask the nurse, “What is going to
happen to our daughter? Will she walk again?” The best response by the nurse is
a. “I’m sure everything will be okay. She is in good hands.”
b. “The best thing you can do for your child is to act like everything is alright.”
c. “You will have to ask the doctor; he is in surgery right now.”
d. “You must have several fears and concerns. We will let you know the test results as
soon as they are available.”
ANS: D
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The nurse should reassure the parents when appropriate that their child’s hospitalization is indeed
frightening and it is all right to be scared. The nurse should remember to demonstrate interest in
the client as a person and to use listening responses to create an atmosphere of concern. The
nurse should keep the parents continually informed regarding their child’s progress. The nurse
should avoid communication blocks, such as giving false reassurance, telling the client what to
do, or ignoring the concerns; such behavior effectively cuts off therapeutic communication.
DIF: Cognitive Level: Analysis
REF: p. 361
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
Chapter 19: Communicating with Older Adults
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. The nurse is caring for an older adult client. The nurse recognizes that the factor most closely
associated with the older adult’s inability to live independently is
a. chronological age.
b. functional status.
c. relationship needs.
d. social functioning.
ANS: B
More than any other factor, impaired functional status is a determinant of an older adult's
inability to live independently. Stress, acute and chronic illness, and age-related physiologic
changes will influence a person's functional status. Functional status, rather than chronologic
age, should be the stronger indicator of disability-related needs in older adults because functional
impairment is not associated solely with age.
DIF: Cognitive Level: Application
REF: p. 367
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
2. An older adult client tells the nurse, “My life has been a waste.” The nurse recognizes this
statement as demonstrating which aspect of psychosocial development?
a. Ego integrity
b. Ego despair
c. Lack of generativity
d. Isolation
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ANS: B
Erikson’s (1982) model of psychosocial development is used to describe older adult psychosocial
development. His is one of the only developmental models that specifically addresses later
adulthood (> 60 years) as a stage of ego development. Erikson portrays the maturational crisis of
old age as that of ego integrity versus ego despair. Awareness of one’s personal mortality leads to
the psychosocial crisis identified with this last stage of ego development. Ego despair describes
the failure of a person to accept one’s life as appropriate and meaningful. Left unresolved,
despair leads to feelings of emotional desolation and bitterness. Ego integrity relates to the
capacity of older adults to look back on their lives with satisfaction and few regrets, coupled with
a willingness to let the next generation carry on their legacy. Lack of generativity and isolation
are not stages found in the older adult client.
DIF: Cognitive Level: Application
REF: p. 366
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
3. A client has an order for a new medication. When preparing to administer the medication to the
client for the first time, the nurse gets ready to educate the client and the client’s daughter about
the medication. When educating the client and the daughter, the nurse should do all of the
following except
a. observe the client before implementing teaching and gear teaching strategies to
meet the individual needs of the client.
b. direct instructions to the client’s daughter.
c. draw on the client's experiences and interests in planning teaching.
d. make the teaching session short enough to avoid tiring the client.
ANS: B
Assuming that cognitive intact older adults lack the capacity to understand instructions is a
common error. Health care providers often direct instruction to the older adult client's younger
companion, even when the client has no cognitive impairment. This action invalidates the client
and diminishes self-worth. Simple modifications to reduce age-related barriers to learning when
teaching older adults include:
• Explain why the information is important to the client.
• Use familiar words and examples in providing information.
• Draw on the client's experiences and interests in planning teaching.
• Make teaching sessions short enough to avoid tiring the client, and frequent enough for
continuous learning support.
• Speak slowly, naturally, and clearly.
Health teaching for the elderly is critical if they are to master the tasks of old age and maintain
their health. Healthy older adult learning capabilities remain intact, although older adults may
need more time to think about how they want to handle a situation. The sensitive nurse observes
the client before implementing teaching and gears teaching strategies to meet the individual
learning needs of each client. Four aspects of successful aging—fall prevention, adequate
nutrition, socialization, and medication management—lend themselves to health teaching
formats.
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DIF: Cognitive Level: Application
REF: p. 377
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
4. The nurse is caring for an older adult client who has recently experienced losses associated with
deaths of important people in her life. The nurse recognizes that this type of problem challenges
which of Maslow’s hierarchy of needs?
a. Physiological integrity
b. Love and belonging
c. Self-actualization
d. Safety and security
ANS: B
Maslow’s hierarchy of needs helps nurses prioritize nursing actions, beginning with basic
survival needs. Physiological integrity, followed by safety and security, emerge as the most basic
critical issues for aging adults, and need to be addressed first. Love and belonging needs are
challenged by increased losses associated with death of important people. Esteem needs,
especially those associated with meaningful purpose, and independence remain important issues
in later life. Abraham Maslow believed that self-actualization occurs more often in middle aged
and older adults. Love and belonging needs are challenged by increased losses associated with
death of important people. Esteem needs, especially those associated with meaningful purpose,
and independence remain important issues in later life. Abraham Maslow believed that selfactualization occurs more often in middle-aged and older adults.
DIF: Cognitive Level: Application
REF: p. 367
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
5. When communicating with older adult clients, the nurse recognizes that
a. hearing problems can diminish an older person’s ability to interact with others.
b. hearing loss associated with normal aging begins after age 40 years.
c. older adults who experience hearing loss initially cannot hear lower-frequency
sounds of vowels.
d. older adults distinguish sounds better against background noises.
ANS: A
Hearing problems can diminish an older person’s ability to interact with others, attend concerts
and other social functions, and understand medical directions. Hearing loss associated with
normal aging begins after age 50 due to loss of hair cells (which are not replaced) in the organ of
Corti in the inner ear. This change leads initially to a loss in the ability to hear high-frequency
sounds (e.g., f, s, th, sh, ch) and is called presbycusis. Lower-frequency sounds of vowels are
preserved longer. Older adults have special difficulty in distinguishing sounds against
background noises and in understanding fast-paced speech.
DIF: Cognitive Level: Knowledge
REF: p. 369
TOP: Step of the Nursing Process: Assessment
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MSC: Client Needs: Psychosocial Integrity
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6. When assessing an older adult client, the nurse recognizes the client has a significant hearing
loss. The most appropriate intervention by the nurse is to
a. introduce herself first.
b. shout into the client’s good ear.
c. repeat words the client doesn’t understand.
d. check the hearing aid batteries.
ANS: D
Adaptive strategies for hearing loss include helping older adults adjust hearing aids. Older adults
lack fine-motor dexterity and may not be able to insert aids correctly to amplify hearing. The
nurse should make sure hearing aids are turned on. If difficulties persist, the nurse should check
the batteries. Adaptive strategies for hearing loss also include addressing the person by name
before beginning to speak (it focuses attention) and speaking slowly and distinctly. If the nurse’s
voice is high pitched, the nurse should lower it and rephrase rather than repeat words if the older
adult doesn’t understand certain words.
DIF: Cognitive Level: Application
REF: p. 370
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
7. The nurse has just completed a care plan on a visually impaired client. Which of the following
interventions is most appropriate for this client?
a. Stand away from the client when communicating to not obstruct the view of the
immediate environment.
b. Provide the client with reading material that has all capital letters.
c. Verbally explain all written information while discouraging the client from asking
questions.
d. Ensure the client’s room has bright lighting with no glare.
ANS: D
Adaptive strategies for vision loss include providing bright lighting with no glare, having the
nurse stand in front of the client, and considering the font and letter size for readability when
using written materials. Upper and lower case letters rather than all capitals should be used. Solid
paper with sharp, contrasting writing and a lot of white space should also be used. Adaptive
strategies for vision loss also include verbally explaining all written information while allowing
time for the client to ask questions.
DIF: Cognitive Level: Application
REF: pp. 370-371
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
8. The nurse is caring for a frail older adult client who is admitted to the hospital after falling. The
client has been living alone independently and appears reluctant to accept assistance. The nurse
recognizes that the client’s reluctance to accept assistance is most likely caused by fear of
a. inability to pay for services.
b. additional financial burden on the family.
c. relinquishing independent living.
d. loss of privacy.
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ANS: C
The nurse may need to directly observe environmental supports, bearing in mind that a potential
association exists in the older adult’s mind between accepting help and relinquishing independent
living.
DIF: Cognitive Level: Application
REF: p. 374
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
9. When visiting a client in his or her home, the home health nurse notes that the client frequently
shifts the conversation to reminisce. Which of the following communication techniques would be
most effective for the nurse to use with this client?
a. Restating
b. Changing the subject
c. Providing information
d. Asking about the client’s life history
ANS: D
Older adults appreciate having the nurse provide structure to the history-taking interview by
explaining the reasons for it and what it will involve. Asking clients to share something about
themselves and their life history, apart from the reasons for the health visit or admission, helps to
establish rapport and increases the client’s comfort level. By relating their life stories and
exploring options relevant to their current health situation, older adults are able to step back and
look at their situation in the present from a broader perspective. Nurses get to know the client as
a person rather than categorically as an “older adult.” Ego integrity relates to the capacity of
older adults to look back on their lives with satisfaction and few regrets, coupled with a
willingness to let the next generation carry on their legacy. Integrity involves acceptance of
“one’s one and only life cycle” as something that had to be and that by necessity permitted of no
substitution. Acceptance develops through self-reflection and dialogue with others about the
meaning of one’s life. Nursing strategies encouraging life review and reminiscence groups
facilitate the process. Old age “is shaped by a lifetime of experience.” Assessment of older adult
clients begins with their story. As they relate their story, the nurse should look for value-laden
psychosocial issues (e.g., independence, fears about being a burden, role changes, and
vulnerability) and client preferences. These are significant issues for older adult clients that may
not be directly expressed.
DIF: Cognitive Level: Application
REF: p. 368
TOP: Step of the Nursing Process: Intervention
MSC: Client Needs: Psychosocial Integrity
10. When assessing an older adult client, the nurse notes that the client demonstrates an inability to
take purposeful action even when the muscles, senses, and vocabulary appear to be intact. The
client appears to register on a command but acts in a way that suggests little understanding of
what transpired verbally. The nurse recognizes these assessment findings as consistent with
which of the following conditions?
a. Presbycusis
b. Somatization
c. Apraxia
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d. Polypharmacy
ANS: C
Apraxia, defined as the loss of the ability to take purposeful action even when the muscles,
senses, and vocabulary seem intact, is a common feature of dementia. The person appears to
register on a command but acts in ways that suggest he or she has little understanding of what
transpired verbally. Hearing loss associated with normal aging begins after age 50 years and is
due to loss of hair cells (which are not replaced) in the organ of Corti in the inner ear. This
change leads initially to a loss in the ability to hear high-frequency sounds (e.g., f, s, th, sh, ch)
and is called presbycusis. Although most people weather the necessary losses of life, late life
depression is an often untreated problem in older adults. Unlike symptoms of depression in
younger people, somatization with vague physical complaints may be its first presenting sign.
Polypharmacy is a fact of life for older adults. As people age, many need multiple medications to
maintain a healthy lifestyle. Polypharmacy places older adults at risk for side effects and drug
interactions because of age-related changes in metabolism. Medications in general have a
stronger effect on the older population and take longer to be eliminated from the body.
DIF: Cognitive Level: Knowledge
REF: p. 379
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
11. The nurse is caring for an older adult client who has early moderate cognitive impairment and
has been diagnosed with dementia. When interacting with the client’s family, the nurse should
teach family members that
a. memory for recent events is retained longer than remote memory.
b. it is important to focus on recent events when asking the client questions.
c. reminiscing about the past can cause the client undue distress.
d. reminiscing about the past can be a means of connecting.
ANS: D
Remote memory (recall of past events) is retained longer than memory for recent events. Family
members can be encouraged to reminisce with dementia clients. This can be a meaningful
experience for the family member, even when the client cannot actively engage in the discussion,
because it is a means of connecting. It is not uncommon for a dementia client to show through
facial expression or garbled words that he/she too experiences the connection, even if only for a
fleeting moment. Or it may come later. Asking mild to early moderate cognitively impaired older
adults about their past life experiences serves as a way to connect verbally with those who might
have difficulty telling you what they had for breakfast 2 hours ago.
DIF: Cognitive Level: Application
REF: p. 380
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
12. The nurse is performing an admission assessment on a client with cognitive impairment. When
developing a plan of care for this client, the nurse should plan to
a. provide instructions one step at a time.
b. offer several instructions at a time when orienting the client to their room.
c. teach the client new skills using complex instructions with multiple steps.
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d. refrain from mentioning the client’s past life experiences when asking questions.
ANS: A
Cognitively impaired clients have trouble following instructions consisting of multiple steps.
Breaking instructions into single steps helps these clients master tasks that otherwise are beyond
their comprehension. Keep the conversation simple and focused on one step at a time. Asking
mild to early moderate cognitively impaired older adults about their past life experiences is a
way to connect verbally with those who might have difficulty telling you what they had for
breakfast 2 hours ago. Remote memory (recall of past events) is retained longer than memory for
recent events. When cognitively impaired adults share memories, they are giving a gift to the
nurse by sharing part of themselves when they may have very little else to give.
DIF: Cognitive Level: Knowledge
REF: p. 380
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
13. A client diagnosed with dementia is becoming increasingly unable to express complete thoughts
and is having difficulty engaging in simple conversations. When communicating with this client,
the nurse should
a. use words directly applicable to the client’s daily routine.
b. restate ideas using different words in a different sequence.
c. refrain from validating the meaning of the client’s responses.
d. ask the client questions that require more than a yes or no answer.
ANS: A
Instead of using abstract prompts (like a specific time), the nurse should use words directly
applicable to the client’s daily routine, like “before lunch,” to anchor the client’s recognition of
time frames. The nurse should restate ideas using the same words and sequence and validate the
meaning of a client’s response. As dementia progresses, clients become increasingly unable to
express complete thoughts and eventually cannot carry on even simple conversations. The nurse
should use questions that can be answered with a yes or no for clients with less verbal skill. The
nurse should note whether the client’s behavior is consistent with the yes or no answer and
follow up if the behavior is incongruent with the words.
DIF: Cognitive Level: Application
REF: p. 380
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
14. The nurse is caring for an older adult client who has been diagnosed with dementia. The nurse
recognizes which of the following as true in relation to the use of touch with this client?
a. Clients with dementia can ask for touch.
b. Clients with dementia can create touch for themselves.
c. Clients with dementia can become more anchored in the present time, space, and
humanity when touched.
d. Clients with dementia can tell the nurse about the meaning of touch.
ANS: C
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Touch is something clients with dementia can no longer ask for, create for themselves, or tell
another of its meaning. Touch is a form of communication, used to reinforce simple verbal
instructions with cognitively impaired adults and as a primary form of communication. It is
experienced "not only physically as sensation, but also affectively as emotion and behavior." As
dementia progresses, gentle touch can anchor an anxious or disoriented person in present time,
space, and humanity. When used to gain a client's attention or to guide a person toward an
activity, touch can acknowledge a client's stress, calm an agitated client, or provide a sense of
security. In general, clients with dementia appreciate the use of touch.
DIF: Cognitive Level: Knowledge
REF: p. 381
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
15. When caring for an older adult client who is experiencing memory loss, the nurse notes that the
client emotionally overreacts to situations, appearing as if having temper tantrums when
responding to real or perceived frustration. The nurse recognizes the client is experiencing a
catastrophic reaction. When caring for this client, the nurse should
a. attempt to keep the client awake for extended periods of time.
b. demand the client stop demonstrating inappropriate behavior.
c. increase the client’s environmental stimuli.
d. use distraction to move the client away from the offending environmental stimuli.
ANS: D
Instead of focusing on the behavior, the nurse should try to identify and eliminate the cause(s).
The nurse should use distraction to move older adults away from the offending stimuli in the
environment or use postponement. Older adults with memory loss lack the cognitive ability to
develop alternatives. They emotionally overreact to situations and can have what look like
temper tantrums in response to real or perceived frustration. Older adult tantrums are called
catastrophic reactions and represent a completely disorganized set of responses. Usually there is
something in the immediate environment that precipitates the reaction. Fatigue, multiple
demands, overstimulation, misinterpretations, or an inability to meet expectations are
contributing factors.
DIF: Cognitive Level: Knowledge
REF: p. 382
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
16. When performing a mental status examination on an older adult client, the nurse discovers that
the client is illiterate and only has a third-grade education. How should the nurse assess the
client’s cognition?
a. Have the client spell the word “world” backwards.
b. Have the client spell the word “world” forwards.
c. Ask the client to perform serial 7s.
d. Instruct the client to state the days of the week backwards.
ANS: D
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The nurse should determine the client’s level of formal education. If the client never learned to
spell, it will be impossible to spell “world” backwards. Saying the days of the week backwards is
a good alternative. Spelling and use of serial 7s would not be an appropriate alternative with this
client’s level of formal education.
DIF: Cognitive Level: Application
REF: p. 371
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
Chapter 20: Communicating with Clients in Crisis
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. A client experiences an unusually stressful life event that exceeds their
resources and coping skills. The nurse recognizes the client is experiencing
which type of crisis?
a.
Developmental
b.
Private
c.
Adventitious
d.
Situational
ANS: D
A situational crisis is an unusually stressful life event that exceeds a person’s
resources and coping skills. Examples include unexpected illness or injury,
rape, car accident, loss of home, spouse, job, etc. Erik Erikson’s stage model
of psychosocial development forms the basis for understanding
developmental crises. Each stage is associated with a psychosocial crisis to
be resolved. Successful resolution of each maturational stage leaves a
person better able to meet the interpersonal challenges and stressors of the
next. Examples of critical incidents associated with developmental crises
include: marriage, pregnancy and birth of a child, midlife crisis, retirement,
meaning in aging, etc. A private crisis affects individuals and families but not
the community at large. Examples include suicide, terminal diagnosis, a car
crash, rape, or the death of a family member. An adventitious crisis is not a
part of everyday experience. It is unplanned, unusual, horrific, and beyond
anyone’s control. Examples of adventitious crisis include natural disasters
such as floods, earthquakes, fires, mud slides; national disasters such as
terrorism, riots, wars; and crimes of violence such as rape, child abuse,
assault, or murder.
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DIF: Cognitive Level: Application REF: p. 388
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. A model of psychosocial development in which each stage is associated with
a psychosocial crisis to be resolved was developed by which theorist?
a.
Caplan
b.
Erikson
c.
Aguilera
d.
Roberts
ANS: B
Erikson’s stage model of psychosocial development forms the basis for
understanding developmental crises. Each stage is associated with a
psychosocial crisis to be resolved. Successful resolution of each maturational
stage leaves a person better able to meet the interpersonal challenges and
stressors of the next. Lindemann and Caplan are considered primary
contributors to the development of crisis theory. Caplan broadened
Lindemann’s model to include developmental crisis and personal crisis.
Although the direct focus of crisis intervention is on secondary prevention
because the crisis state is already in motion, Caplan applied concepts of
primary, secondary, and tertiary prevention to crisis intervention. Aguilera
developed a nursing model identifying how a crisis develops and
corresponding factors needed for resolution. Roberts provides a seven-stage
sequential blueprint for clinical intervention, which can be used to structure
the crisis intervention process in nurse-client relationships. This model is
compatible with the nursing process sequencing of assessment, planning,
implementation, and evaluation.
DIF: Cognitive Level: Knowledge REF: p. 388
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
3. When educating a student nurse about the definition of a crisis state, the
nurse recognizes that additional instruction is needed when the student
nurse states,
a.
“A crisis state is an acute normal
human response.”
b.
“A crisis state is a mental illness.”
c.
“A crisis state represents a
personal response.”
d.
“A crisis state creates a
temporary disconnect from
attachment to others.”
ANS: A —> B??
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Everly defines a crisis state as an acute normal human response to severely
abnormal circumstances; it is not a mental illness. Because a crisis state
represents a personal response, two people experiencing the same crisis
event will respond differently to it. A crisis state creates a temporary
disconnect from attachment to others, loss of meaning, and a disruption of
previous mastery skills.
DIF: Cognitive Level: Application REF: p. 387
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
4. The nurse is caring for a client who is experiencing a crisis situation. The
nurse recognizes that after feeling a sense of shock, the client will go
through a period of recoil in which the client
a.
behaviors can appear normal to
outsiders.
b.
takes constructive actions to face
and resolve the reality issues
present.
c.
achieves at least precrisis
functioning.
d.
experiences variations in
emotions.
ANS: A
Caplan described the initial response to a crisis situation as shock, with
variations in emotions ranging from anger, laughing, hysterics, crying, and
acute anxiety to social withdrawal. Then follows an extended period of
adjustment, a period of recoil. This period can last from 2 to 3 weeks. Client
behaviors can appear normal to outsiders, but the person often describes
nightmares, phobic reactions, and flashbacks of the crisis event. Caplan uses
the term restoration or reconstruction to describe the final phase of crisis
intervention. This phase involves taking constructive actions to face and
resolve the reality issues present in a crisis situation. If successfully
negotiated, the person achieves precrisis functioning, or better.
DIF: Cognitive Level: Application REF: p. 389
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
5. A client is admitted to a psychiatric unit for crisis intervention. When caring
for this client, the nurse recognizes that crisis intervention is
a.
a long-term treatment to improve
coping skills.
b.
a system for focusing on future
problem-solving skills.
c.
a method of intervention with a
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d.
goal of returning the client to a
level of functioning higher than
their precrisis level.
a time-limited treatment focused
on the immediate problem and its
resolution.
ANS: C
Crisis intervention is a time-limited treatment that focuses only on the
immediate problem and its resolution. The goal of crisis intervention is to
return the client to his or her precrisis level of functioning.
DIF: Cognitive Level: Application REF: p. 404
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
6. A client who is experiencing a crisis is admitted to a nursing unit. When
entering the client’s room, the nurse should attempt to establish rapport and
engage the client by
a.
offering a brief introductory
statement to quickly orient the
client to the purpose of crisis
questions.
b.
demonstrating an inflexible
approach when caring for the
client.
c.
placing the client in a dimly lit
room close to the nursing unit.
d.
delegating to several nurses the
role as primary contact for
information.
ANS: A
Clients in crisis look to health professionals to structure interactions.
Introduce yourself briefly, and quickly orient the client to the purpose of the
crisis questions and how the information will be used. Clients and families
experiencing a crisis state require a compassionate, flexible, but clearly
directive calm approach from nurses. The client should be placed in a quiet,
lighted room with no shadows, away from the mainstream of activity. Ideally,
one nurse should be the primary contact for information.
DIF: Cognitive Level: Application REF: p. 390
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
7. A client states, “I feel like I have no control over my life.” The nurse
determines the client is experiencing a sense of powerlessness. Which
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strategy most likely assisted the nurse in the identification of powerlessness?
a.
Looking for central emotional
themes in the client’s story
b.
Keeping the focus on the future
c.
Providing lengthy responses
when interacting with the client
d.
Ignoring vocal inflections as the
client speaks
ANS: A
A guideline for identifying major problems is to identify central emotional
themes in the client’s story (e.g., powerlessness, shame, hopelessness) to
provide a focus for intervention. Another guideline for identifying major
problems is to keep the focus on the here and now. Questions should be
short and relevant to the crisis. Responses to the client should be brief,
empathetic, and clearly related to the client’s story. Note changes in
expression, body posture, and vocal inflections as clients tell their story and
at what points they occur.
DIF: Cognitive Level: Application REF: p. 391
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
8. The nurse is caring for a family that is experiencing a crisis. The nurse
recognizes that interventions for initial family responses to crisis include
a.
minimizing the family’s sense of
control within the hospital
environment.
b.
prohibiting extreme expression of
feelings.
c.
providing the family with
information that is lengthy and
abstract.
d.
repeating and frequently
reinforcing information.
ANS: D
Interventions for initial family responses to crisis include repeating
information and frequently reinforcing it. They also include the following:
maximizing control within the hospital environment; providing for and
encouraging or allowing expression of feelings, even if they are extreme; and
giving information that is brief, concise, explicit, and concrete.
DIF: Cognitive Level: Application REF: p. 395
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
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9. When a disaster strikes within a community, the shock of the disaster pulls
people together and outside resources are brought in. This is known as which
phase of the community response to disaster?
a.
Reconstruction
b.
Honeymoon
c.
Heroic
d.
Disillusionment
ANS: B
The honeymoon phase occurs when the “community pulls together and
outside resources are brought in” after an initial search and recovery phase.
The final reconstruction phase occurs when the survivors begin to take the
primary responsibility for rebuilding their life. The heroic phase consists of
initial search and recovery. The disillusionment phase usually appears as the
initial emergency response starts to subside. The “shared community”
feeling starts to leave as people begin to realize the extent of their losses
and the limitations of external support. Survivors can experience anger,
resentment, and bitterness at the loss of support, particularly if it is sudden
and complete.
DIF: Cognitive Level: Knowledge REF: p. 402
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Psychosocial Integrity
10. An older adult client who is mourning the death of her spouse comes to the
health clinic for follow-up care for an irregular heartbeat. During the
examination the client tells the nurse, “I don’t care about my irregular
heartbeat; I will be with my husband soon.” The best response by the nurse
is,
a.
“It sounds as if you would like to
see your husband again.”
b.
“Your husband is dead and you
have so much to live for.”
c.
“Your heartbeat was good today.
The medication seems to be
working.”
d.
“Have you talked to your children
recently about how you’re
doing?”
ANS: A
When a nurse responds with “It sounds as if you would like to see your
husband again,” it is an example of a reflective listening response used to
identify applicable feelings. Responses that focus on what the client has to
live for, the medication, or her children are not examples of therapeutic
communication.
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DIF: Cognitive Level: Analysis
REF: p. 391
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
11. A client is admitted to a psychiatric unit with severe depression and thoughts
of suicide. The client is placed on suicide precautions. When caring for this
client, the nurse recognizes that
a.
people who talk about harming
themselves are at less risk.
b.
clients who verbalize or
behaviorally demonstrate “a
weight being lifted off the
shoulders” are no longer at risk.
c.
once the acute crisis has
subsided, the client is no longer
at risk.
d.
a major goal in evaluating
suicidal risk is to assess for
imminent danger of doing harm
to self.
ANS: D
A major goal in evaluating suicidal risk is to assess whether the client is
imminent danger of doing harm to self. It is a myth that people who talk
about harming themselves are at less risk. Clients who verbalize or
behaviorally demonstrate “a weight being lifted off the shoulders” should be
watched carefully. Suicidal ideation waxes and wanes, so careful observation
is critical even after the acute crisis has subsided.
DIF: Cognitive Level: Application REF: p. 398
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
12. The nurse is performing an initial assessment on a mental health client in the
emergency department. The client is uncooperative, and the nurse
recognizes the client’s behavior is escalating. The most appropriate response
by the nurse is to
a.
use a vulnerable stance.
b.
maintain constant eye contact.
c.
move quickly with hands hidden
behind back.
d.
ignore provocative statements.
ANS: D
Deescalation tips for mental health emergencies:
• Use a nonthreatening stance—open, but not vulnerable. Have them "take
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
a seat"
Eye contact—not constant, brief to show concern
Commands—brief, slow, with simple vocabulary, only as loud as needed,
repeat as needed
Movement—not sudden, announce actions when possible, keep hands
where they can be seen
Attitude—calm, interested, firm, patient, reassuring, respectful, truthful
Acknowledge legitimacy of feelings, delusions, hallucinations as being
real to the client ("I understand you are seeing or feeling this, but I am
not")
Remove distractions, upsetting influences
Keep the client talking/focused on the here and now
Ignore, rather than argue with, provocative statements
Allow verbal venting, within reason
Be sensitive to personal space/comfort zone
Remove client to a quiet space; remove others from immediate area
(avoid the "group spectators")
Give some choices or options, if possible
Set limits, if necessary
Limit interaction to just one professional and let that person do the
talking
Avoid rushing—slow things down
Give yourself an out; don't put the client between yourself and the door
DIF: Cognitive Level: Application REF: p. 397
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
13. The nurse is communicating with a client who is experiencing a crisis related
to marital difficulties. Which of the following statements made by the nurse
is the best example of therapeutic communication when working with this
client?
a.
“I think we should work toward
fixing your marital difficulties
immediately.”
b.
“I’m going to call the counselor
and make an appointment for
you.”
c.
“What would happen if you chose
to go for counseling compared to
seeking a divorce?”
d.
“I think you and your spouse
need to go for counseling as soon
as possible.”
ANS: C
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Clients in crisis generally feel powerless. Nurses can introduce alternative
methods that the client may not have considered. Helping a client examine
the consequences of proposed solutions and breaking tasks down into small,
achievable parts empowers clients. Proposed solutions should accommodate
both the problem and client resources. It’s helpful to assist clients in
discussing the consequences, costs, and benefits of choosing of one action
versus another (e.g., “What would happen if you chose this course of action
as compared to…?” or “What is the worst that could happen if you decided
to…?”). The locus of control for decision making should always remain with
the client to whatever extent is possible. Making autonomous choices
encourages clients to become invested in the solution-finding process and
hopeful about finding a resolution to a crisis situation.
DIF: Cognitive Level: Application REF: p. 392
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
14. The nurse is caring for an older adult client who has recently lost his job, is
experiencing a major physical illness, and lives alone. The client states, “I
sometimes wish I wasn’t here.” When working with this client, the nurse
recognizes that
a.
an increase in the client’s energy
level indicates the client is coping
better.
b.
older adult clients have a lower
rate of suicide.
c.
the client should be assessed for
imminent danger of doing harm
to self.
d.
when the client begins giving
away possessions, it is a positive
sign.
ANS: C
Verbal indicators of potential suicide include statements such as “I don’t
think I can go on without . . .”; “I sometimes wish I wasn’t here”; or “People
would be better off without me.” Risk factors for suicide include a major
physical illness, social isolation, and a recent major loss. A major goal in
evaluating suicidal risk is to assess whether the client is in imminent danger
of doing harm to self. Irrational behaviors, drug and alcohol abuse, previous
suicide attempts, and verbal threats are matters of concern, as is a sudden
mood change—especially if the client demonstrates much more energy.
Suicide rates are higher for older adults, especially for white males.
Behavioral indicators of escalating suicidal ideation include giving away
possessions.
DIF: Cognitive Level: Application
REF: p. 398
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TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
15. A client enters the emergency department. When performing the initial
admission assessment, the nurse recognizes which client behavior as an
indicator that the client may become violent?
a.
Coherent speech
b.
Flat affect
c.
A relaxed posture
d.
Confusion
ANS: D
Confusion, paranoid ideation, disorganization, and organic impairment are all
mental status behavioral categories that indicate potential for violence.
Rapid and pressured speech, incoherent speech, menacing tones, raised
voice, and verbal threats are all speech pattern behavioral categories that
indicate potential for violence. A belligerent, labile, or angry affect is an
indicator of potential violence. Eyes darting, prolonged (staring) eye contact,
spitting, pale or red (flushed) face, and a menacing posture are indicators of
potential violence.
DIF: Cognitive Level: Application REF: p. 397
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
16. A client with a history of violence is admitted to a psychiatric unit. The nurse
observes the client pacing the halls and speaking to other clients in a
menacing way. The nurse is concerned that the client will become physically
violent. The nurse should initially
a.
encourage the client to stop
pacing and sit down.
b.
increase environmental stimuli by
promoting more sensory input
c.
call the client by name using a
low, calm tone of voice
d.
refrain from medicating the client
ANS: C
Deescalation tips for mental health emergencies:
• Use a nonthreatening stance—open, but not vulnerable. Have them "take
a seat"
• Eye contact—not constant, brief to show concern
• Commands—brief, slow, with simple vocabulary, only as loud as needed,
repeat as needed
• Movement—not sudden, announce actions when possible, keep hands
where they can be seen
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• Attitude—calm, interested, firm, patient, reassuring, respectful, truthful
• Acknowledge legitimacy of feelings, delusions, hallucinations as being
real to the client ("I understand you are seeing or feeling this, but I am
not")
• Remove distractions, upsetting influences
• Keep the client talking/focused on the here and now
• Ignore, rather than argue with, provocative statements
• Allow verbal venting, within reason
• Be sensitive to personal space/comfort zone
• Remove client to a quiet space; remove others from immediate area
(avoid the "group spectators")
• Give some choices or options, if possible
• Set limits, if necessary
• Limit interaction to just one professional and let that person do the
talking
• Avoid rushing—slow things down
• Give yourself an out; don't put the client between yourself and the door
DIF: Cognitive Level: Application REF: p. 397
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. When working on a psychiatric unit, the nurse recognizes that indicators of
potential violence include which of the following? (Select all that apply.)
a.
Confusion
b.
Orientation
c.
Coherent speech
d.
Exaggerated gestures
e.
Prolonged eye contact
ANS: A, D, E
Indicators of potential violence include confusion, exaggerated gestures, and
prolonged eye contact. Confusion (not orientation) is an indicator of potential
violence. Incoherent (not coherent) speech is an indicator of potential
violence.
DIF: Cognitive Level: Application REF: p. 397
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
2. When collecting assessment data, the nurse recognizes that a client might
be more prone to violent behavior when having a history of which of the
following? (Select all that apply.)
a.
Psychosis
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b.
c.
d.
e.
Childhood abuse
Lack of impulsivity
Mental retardation
Delirium
ANS: A, B, D, E
A history of violence, childhood abuse, substance abuse, mental retardation,
problems with impulse control, and psychosis, particularly when
accompanied by command hallucinations, are common contributing factors
to violent behavior. Problems with impulse control (not lack of impulsivity) is
a common contributing factor to violent behavior.
DIF: Cognitive Level: Application REF: p. 396
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
Chapter 21: Communicating with Clients and Families at the
End of Life
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following statements is true about grief?
a.
Grief always occurs immediately
b.
c.
d.
after a loss.
Support for a grieving client
includes closed communication.
Recurring, wavelike feelings of
sadness and loss are common
feelings in a client who is
grieving.
It is normal for grief to be
exaggerated.
ANS: C
The concept of grief describes the personal emotions and adaptive process a
person goes through in recovering from loss. Common feelings include
sadness and an acute awareness of the void accompanied by recurring,
wavelike feelings of sadness and loss. Grief can occur immediately after a
loss or it can be delayed. Open, empathetic communication is a component
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of support for a client who is grieving. When the symptoms of grief are
exaggerated or absent, it is considered pathologic or complicated grief.
People experiencing complicated grief may require psychologic treatment to
resolve their grief and move into life again.
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: All phases
p. 410
MSC: Client Needs: Psychosocial Integrity
2. Which of the following best describes anticipatory grief?
a.
It occurs after the actual death.
b.
It occurs when death was sudden
c.
d.
and unexpected.
Only the family of the dying client
experiences it.
It can be colored by ambivalent
feelings.
ANS: D
Anticipatory grief is an emotional response that occurs before the actual
death around a family member with a degenerative or terminal disorder. A
person anticipating his or her own death also experiences it. Symptoms can
be similar to those experienced after death and can be colored by
ambivalent feelings. Anticipatory grief is an emotional response that occurs
before the actual death. Anticipatory grief is encountered when an individual
has a degenerative or terminal disorder. A person anticipating his or her own
death also experiences anticipatory grief.
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: All phases
p. 411
MSC: Client Needs: Psychosocial Integrity
3. The nurse is caring for a client who is expected to die within a month. The
client states, “I can’t go on anymore, help me!” Which of the following best
describes this client’s stage of dying?
a.
Anger
b.
Denial
c.
Acceptance
d.
Depression
ANS: D
Kübler-Ross characterizes the depression stage as the “Yes, me” stage,
accompanied by depressive feelings. Mood swings and depressive feelings
are hard for families to tolerate but very common. Kübler-Ross refers to
anger as the “Why me?” stage, associated with feelings about the unfairness
of life or anger with God. Kübler-Ross characterizes the denial stage as the
“No, not me” stage. The acceptance stage is characterized by an
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acknowledgment of the inevitable end of life. As the client approaches death,
there is a gradual detachment from the world, and the person is almost “void
of feeling.” Because of this, there can be a sense of peace.
DIF: Cognitive Level: Analysis
REF: p. 409
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
4. Which of the following is defined as a normal grief response associated with
an ongoing living loss that is permanent, progressive, recurring, and cyclic in
nature?
a.
Somatization disorder
b.
Chronic sorrow
c.
Chronic grief
d.
Absent grief
ANS: B
Chronic sorrow is defined as “a normal grief response associated with an
ongoing living loss that is permanent, progressive, recurring, and cyclic in
nature.” Many parents of children with a physical, developmental, emotional,
or chronic disorder will experience chronic grief. Families need nurses to
affirm their coping efforts and acknowledge the legitimacy of their sadness.
Providing timely support for families when there is an exacerbation of
symptoms can make the situation more manageable. Somatization disorder,
chronic sorrow, and absent grief are all examples of complicated grief.
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: All phases
p. 411
MSC: Client Needs: Psychosocial Integrity
5. The nurse is caring for a client who has been given 6 months to live after
being diagnosed with stage 4 cancer of the lung. Evidence that the client is
in the bargaining stage of death and dying is demonstrated by which of the
following statements?
a.
“Not me.”
b.
“Why me?”
c.
“Yes, me.”
d.
“Let me.”
ANS: C
Kübler-Ross refers to the bargaining stage as the “Yes, me, but…I need just a
little more time.” The bargaining state involves pleading for time extension
or special consideration. “Not me.” represents the denial stage. “Why me?”
represents the anger stage. “Let me.” represents the acceptance stage.
DIF: Cognitive Level: Application REF: p. 408
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Psychosocial Integrity
6. The nurse is caring for a client who has just received biopsy reports that
indicate recurrence of metastatic stage IV breast cancer. The client’s
statement that indicates the acceptance stage of death and dying is,
a.
“The test results are incredible.”
b.
“The test results are positive.”
c.
“The test results are negative.”
d.
“The test results will be repeated
next week.”
ANS: B
The acceptance stage is characterized by an acknowledgment of the
inevitable end of life. “The test results are incredible” indicates the anger
stage. “The test results are negative” indicates the denial stage. “The test
results will be repeated next week” indicates bargaining or denial.
DIF: Cognitive Level: Application REF: p. 409
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
7. Stoicism and denial of grief are examples of how a family coping with death
is affected by
a.
b.
c.
d.
Kübler-Ross.
culture.
developmental level.
prior experience.
ANS: B
Different cultures have distinctive expressions of grief responses. Kübler-Ross
is an author who wrote about death and dying. Developmental level and
prior experience will influence a family’s ability to cope, but stoicism and
denial specifically are affected by cultural influences.
DIF: Cognitive Level: Knowledge REF: p. 419
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
8. A client has just been transferred to a new facility from another hospital at
his insistence. The client is demanding a second opinion because he feels
that “They must have made a mistake.” The nurse recognizes that the best
communication technique to use with this client is to
a.
clarify the client’s response.
b.
reflect the client’s behavior.
c.
summarize the client’s behavior.
d.
acknowledge the client’s feelings.
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ANS: B
Denial is a coping mechanism being used by this client. Personal reflections
are critical sources of assessment data. Once rapport is established, the
nurse should ask the client how he learned of his diagnosis. The nurse must
accept the client’s way of dealing with the stress and readiness to talk.
Feelings are blocked during denial.
DIF: Cognitive Level: Application REF: p. 425
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
9. The nurse is caring for an 8-year-old child in the school nurse’s office
because the child received a bloody nose in a scuffle with another child
during recess. The nurse discovers that the child’s parents have recently
divorced. The nurse recognizes that the child
a.
still has both parents and should
not be experiencing a sense of
loss.
b.
has gotten over his grief because
he is able to play outside.
c.
needs to be referred for grief
counseling.
d.
demonstrates behavior that is a
common response when grieving.
ANS: D
Children don’t express their grief in the same way as adults. Acting out,
anger, fear, and crying are common responses, which appear spontaneously.
Divorce is a significant loss to a child. Children express their grief differently
from adults; they can be sad one minute and then playing the next. The child
may need counseling in the future if the behavior continues and if the
parents are unable to help him work through the emotional turmoil, but this
is not an initial intervention.
DIF: Cognitive Level: Analysis
REF: p. 421
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
10. When evaluating care of dying clients, the nurse recognizes that
interventions have been unsuccessful if the
a.
client does not get past the stage
of denial.
b.
client dies in peace surrounded
by loved ones.
c.
client dies while experiencing
pain.
d.
nurse refuses to allow the client
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to be sad.
ANS: D
The concept of grief describes the personal emotions and adaptive process a
person goes through in recovering from loss. Common feelings include
sadness and an acute awareness of the void accompanied by recurring,
wavelike feelings of sadness and loss. Some clients cope by remaining in the
denial stage. This is the client’s right. When a client dies in peace surrounded
by loved ones, it is evidence of successful interventions. Sometimes a
peaceful death is not possible, but that does not mean the intervention was
ineffective.
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: Evaluation
p. 411
MSC: Client Needs: Psychosocial Integrity
11. The nurse is caring for a 15-year-old client who is dying. The client tells the
nurse, “I know I am not going home again. I think it is harder for my parents
than me. Will you talk to them for me?” Which of the following is the best
response by the nurse?
a.
“It is true that you will be dying
soon, but you must be honest
with your parents.”
b.
“That’s not true, but I will talk to
your parents.”
c.
“You are having a bad day, so I
will be back later to see if you
need anything else.”
d.
“Yes, I will talk to your parents,
but you need to talk to them also.
I will help you with that.”
ANS: D
Nurses are key informants about client status and changes in the client’s
condition. There are fundamental differences in the level of information an
individual or family will desire. The response of the client should determine
the content and pace of sharing information. Talking with families about care
details and potential outcomes should happen often, but even more
frequently when the client’s health status begins to decline or show a
change. It is often difficult for families to talk about death, and the nurse can
facilitate communication. It is important to be honest; false information and
reassurances can increase feelings of isolation.
DIF: Cognitive Level: Analysis
REF: p. 422
TOP: Step of the Nursing Process: Intervention
MSC: Client Needs: Psychosocial Integrity
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12. Which of the following is an inappropriate intervention for communicating
with terminally ill clients?
a.
b.
c.
d.
Allowing the client to lead
discussions about the future
Offering automatic responses and
trite reassurances
Respecting the individual’s
pattern of communication
Maintaining a sense of calm
ANS: B
Guidelines for communicating with dying clients include avoiding automatic
responses and trite reassurances. Allowing the client to lead discussions
about the future, respecting the individual’s pattern of communication, and
maintaining a sense of calm are all guidelines for communicating with
terminally ill clients
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: Implementation
p. 417
MSC: Client Needs: Psychosocial Integrity
13. Which of the following is a dimension of palliative care?
a.
It involves only care of the client.
b.
It provides grief support for
c.
d.
family only while the client is
alive.
It bears no resemblance to
hospice care.
It intends neither to hasten nor
postpone death.
ANS: D
Dimensions of Palliative Care
• Provides relief from pain and other distressing symptoms
• Affirms life and regards dying as a normal process
• Intends neither to hasten nor postpone death
• Integrates the psychologic and spiritual aspects of client care
• Offers a support system to help clients live as actively as possible until
death
• Offers a support system to help the family cope during the client’s illness
and in their own bereavement
• Uses a team approach to address the needs of clients and their families,
including bereavement counseling, if indicated
• Will enhance quality of life and may also positively influence the course of
illness
• Is applicable early in the course of illness, in conjunction with other
therapies that are intended to prolong life, such as chemotherapy or
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radiation therapy, and includes those investigations needed to better
understand and manage distressing clinical complications
DIF: Cognitive Level: Application REF: p. 413
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
14. An 89-year-old client recently lost his wife of 69 years to cancer. He reports “I
had the strangest thing happen to me last night. I woke up and saw my wife
sitting in her chair.” The nurse’s best response would be:
a.
“How long have you been
hallucinating?”
b.
“Hallucinations are often caused
by disturbance in brain
chemicals.”
c.
“Hearing or seeing things that are
not real can be a normal
response to extreme stress.”
d.
“I recommend you speak to your
doctor to review your
medications.”
ANS: C
In the shock and disbelief phase, a newly bereaved person may feel
alienated or detached from normal—“literally numb with shock; no tears, no
feelings, just absolute numbness.” Seeing or hearing the lost person, or
sensing his or her presence, is a normal, temporary altered sensory
experience related to the loss, which should not be confused with psychotic
hallucinations.
DIF: Cognitive Level: Analysis
REF: p. 409
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
15. A 21-year-old client informs the nurse that he is not sleeping. The nurse
learns that the client’s girlfriend was killed in a car accident 1 month ago.
Which statement would be of most concern to the nurse?
a.
“I am moving on and plan to start
dating again.”
b.
“It’s my fault. I shouldn’t have let
her go out that night.”
c.
“I wish I died in the car accident
instead of her.”
d.
“I cannot sleep because I keep
reliving the car accident.”
ANS: A
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Complicated grief can appear as an absence of grief in situations where it
would be expected. When deaths and important losses are not mourned, the
feelings don’t just disappear; they reappear in unexpected ways, sometimes
years later. Subsequent losses trigger an extreme reaction to a current loss.
Complicated grief can result in clinical symptoms such as depression or
anxiety disorders that require professional help. Blaming oneself, wanting to
take the place of those who dies, and having sleep problems are normal grief
reactions that occur in sudden or traumatic situations.
DIF: Cognitive Level: Analysis
REF: p. 409
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
16. Which of the following individuals is most likely experiencing a delayed grief
reaction?
a.
b.
c.
d.
A 22-year-old army pilot on leave
from the Iraq war who talks about
the death of his crew member
A 93-year-old women, whose
husband of 73 years died 1 year
ago, who reminisces about their
life together
A 54-year-old man suffering from
alcoholism who just completed a
28-day inpatient rehabilitation
talking about the death of his
wife 3 years ago
A child whose parents were
divorced 3 months ago and is
acting out at school
ANS: C
Eric Lindemann pioneered the concepts of grief work based on interviews
with bereaved persons suffering a sudden tragic loss. He described patterns
of grief and the physical and emotional changes that accompany significant
losses. Lindemann observed that grief can occur immediately after a loss, or
it can be delayed. When symptoms of grief are exaggerated or absent, it is
considered pathologic or complicated grief. People experiencing complicated
grief may require psychologic treatment to resolve their grief and move into
life again. The pilot is talking about the death; there is no evidence
symptoms of grief are absent. Anniversaries will often trigger memories.
Children often show regressive behavior, anger, or fear in response to the
loss of a parent.
DIF: Cognitive Level: Application REF: p. 409
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
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17. The nurse is caring for a client who has just experienced the death of her
mother. The nurse best demonstrates support for the client by
a.
sitting quietly with the client and
not discussing the loss.
b.
reminding the client that her
mother lived a long life.
c.
changing the subject so the client
won’t get upset.
d.
offering spiritual support for the
client and family.
ANS: D
Spiritual support for clients and family should be offered. Sitting quietly with
the grieving client is supportive, but the grieving client should be
encouraged to talk about the loss. Trite reassurances are not supportive.
DIF: Cognitive Level: Application REF: p. 424
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
18. A client’s adult children call the nurse hourly with concerns about their
mother’s death and end-of-life care. The nurse’s best response is to
a.
provide detailed, scientific
information.
b.
discuss physical symptoms.
c.
withhold information to avoid
unnecessary fears.
d.
provide frequent updates.
ANS: D
Immanent Death: Family Communication Needs
• Honest and complete answers to questions; repetition and further
explanation, if needed
• Updates about the client's condition and changes as they occur
• Clear, understandable explanations, delivered with empathy and respect
• Frequent opportunities to express concerns and feelings in a supportive,
unhurried environment
• Information about what to expect—physical, emotional, spiritual—as
death approaches
• Discussion of whom to call, legal issues, memorial or funeral planning
• Conversation about cultural and/or religious rituals at time of and after
death
• Appreciation of the conflicts that families experience when the illness
dictates that few options exist; for example, a frequent dilemma is
whether life support measures are extending life or prolonging the dying
phase
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• Short, private times to be present and/or minister to the client
• Permission to leave the dying client for short periods with the knowledge
that the nurse will contact the family member if there is a change in
status
DIF: Cognitive Level: Application REF: p. 424
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
Chapter 22: Role Relationships and Interprofessional Communication
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which aspect of role standards is influenced by institutional norms and may vary depending on
the work environment?
a. Role pressures
b. Role performance
c. Role relationship
d. Role socialization
ANS: B
Role is defined as a traditional pattern of behavior and self-expression performed by or expected
of an individual within a given society. People develop social and professional roles throughout
life. Some are conferred at birth (ascribed roles) and some are attained (acquired roles) during a
lifetime. Work role relationships have structural components—for example, direct reports,
student, nursing, and interdisciplinary professional. Other role relationships are collegial, based
on friendship or common interests. Personal role performance standards reflect personal, social,
cultural, gender, institutional, and family expectations. Standards for role performance tend to
mirror differentiated practice roles, as supported by education, professional licensure, and
certifications. Role performance standards are also influenced by institutional norms and may
vary depending on the work environment. Features of professional role relationships are
recognizable through differences in work responsibilities, cooperative activities, education, and
social affiliations. Stronger personal and professional role expectations are held for those holding
public trust roles, such as elected political and religious leaders, health care professionals, and
teachers.
DIF:
Cognitive Level: Knowledge
REF: p. 428
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TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
2. A nurse, who has been practicing for 4 years, demonstrates competence, speed, and flexibility
when performing clinical skills. According to Benner, the nurse is practicing at which
developmental stage?
a. Advanced beginner
b. Competency
c. Proficiency
d. Expert
ANS: C
The proficiency stage occurs 3 to 5 years into practice. Nurses in this stage are self-confident
about their clinical skills and perform them with competence, speed, and flexibility. The
proficient nurse sees the clinical situation as a whole, has well-developed psychosocial skills,
and knows from experience what needs to be modified in response to a given situation.
DIF: Cognitive Level: Application
REF: p. 436
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
3. The new graduate nurse is unsure how to operate a new intravenous pump After reading the
directions, the new graduate nurse seeks the assistance of a more experienced nurse and asks for
a demonstration on how to operate the new intravenous pump. The behavior exhibited by the
new graduate nurse is
a. role pressure.
b. role clarity.
c. role conflict.
d. role overload.
ANS: B
Professional role clarity is an essential quality of effective leadership. If nurses aren’t clear about
their professional roles, it becomes very difficult for them communicate their value as health care
providers to other professionals. Role clarity about professional competencies is necessary to
support client safety initiatives and lead to improved client outcomes. Influencing change and
making difficult decisions becomes easier when nurses have a clear vision that emanates from
their understanding of their professional role because they are better able to stimulate confidence
in others.
DIF: Cognitive Level: Knowledge
REF: p. 432
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
4. The economics of health care and diminishing numbers of health care providers led to legislative
passage of the Patient Protection and Affordable Care Act (PPAC). This legislation is designed to
a. provide high-quality health care to a smaller number of people.
b. make health care accessibility a reality for all.
c. provide high-quality health care at a slightly increased cost.
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d. make health care accessibility a reality for individuals with the means to pay.
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ANS: B
The economics of health care and diminishing numbers of health care providers led to legislative
passage of the PPAC. This legislation is designed to make health care accessibility a reality for
all. In 2012, the Supreme Court issued a historic decision to uphold this legislation. With this
legislation comes a mandate for providing high-quality health care to a greater number of people
at a lower cost, all at a time when there is a growing shortage of nurses and physicians. The
shortage is expected to increase dramatically over the next decade.
DIF: Cognitive Level: Application
REF: p. 429
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
5. A novice nurse decides to attend a diabetes workshop after a client was admitted to the unit with
an insulin pump that the nurse was not familiar with. This is an example of
a. role performance.
b. client advocacy.
c. collaboration.
d. professional self-awareness.
ANS: D
Professional self-awareness promotes recognition of the need for continuing education, the
acceptance of accountability for one’s own actions, the capacity to be assertive with professional
colleagues, and the capability to serve as a client advocate when the situation warrants it, even if
it is uncomfortable to do so. Role performance is role functioning. Client advocacy is protecting
client rights. Collaboration is sharing responsibility.
DIF: Cognitive Level: Application
REF: p. 440
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
6. The nurse is caring for a client on a rehabilitation unit who sustained a back injury in an auto
accident, resulting in disability status from his job as a truck driver. The nurse should help the
client to identify skills transferable to a future position by stating which of the following?
a. “I am sorry to learn about your job loss.”
b. “Your wife stated you were a reliable, trustworthy worker.”
c. “Think of your strengths associated with your previous job position.”
d. “The career office really considers you employable.”
ANS: C
Collaborative professional teams represent a coordinated form of care delivery. Each team
member pools his or her expertise with that of other team members to achieve common, agreed
upon treatment outcomes. The precise role and involvement of each discipline-specific team
member depends on team member expertise and the individualized needs of clients. The setting,
professional, and system resources enable or hinder team functioning. For example, in the ICU,
care will focus on the life-threatening nature of the client’s condition, requiring the concentrated
assistance of specialists. In rehabilitation and home care settings, the composition of team
members would be different. However, similar overarching goals of achieving health outcomes
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and improving a client’s quality of life underscore clinical team efforts.
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DIF: Cognitive Level: Analysis
REF: pp. 434-435
TOP: Step of the Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
7. The nurse offers a client’s family a list of community resources and support groups and
encourages them to become involved in the local Lupus chapter. This is an example of which
professional nursing role responsibility?
a. Client advocate role
b. Teaching role
c. Caregiver role
d. Consultant role
ANS: A
Nursing actions that constitute client advocacy include facilitating access to essential health care
services for clients, ensuring high-quality care, protecting client rights, and acting as a liaison
between clients and the health care system to procure high-quality care.
DIF: Cognitive Level: Application
REF: p. 445
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
8. The nurse is caring for an older client with a fractured hip. The client asks the nurse about the
nature of her condition. The nurse’s response should be,
a. “You have a fractured femur,” stated in a loud voice.
b. “You will have to speak to your physician about your diagnosis.”
c. “Do you wish to call your son to discuss it with him because he talked with the
MD?”
d. “When you fell at home, you broke your hip.”
ANS: D
Clear communication, altruism, caring, and professional ethics are essential components of
interprofessional professionalism. In saying loudly that the patient has a fractured femur, the
nurse is stereotyping the client as hard of hearing and providing information she may not
understand. The patient has the right to receive information from a direct caregiver other than the
physician. The client’s confidentiality may have been breached when the son was informed of
her condition without her knowledge.
DIF: Cognitive Level: Application
REF: p. 439
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Psychosocial Integrity
9. The nurse is conducting an interview with the family of a client who has just been diagnosed
with Alzheimer disease. The nurse wants to assess family role relationships. What would be an
appropriate question?
a. “What are your likes and dislikes?”
b. “Who assumes responsibility for decision making?”
c. “How would you describe your job?”
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d. “How do you like to be treated?”
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ANS: B
Sometimes the nurse serves as dual advocate for both client and family members. It is important
to assess the impact on the family of the illness. It is necessary to find out who the decision
maker is in the family. If it is the client, the diagnosis will have more of an impact on the family.
Asking about likes/dislikes, employment, and how the family members wish to be treated does
not address family role relationships.
DIF: Cognitive Level: Analysis
REF: p. 446
TOP: Step of the Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
10. Essential components of interprofessional professionalism are clear communication, caring,
professional ethics, and
a. aesthetics.
b. altruism.
c. justice.
d. truth.
ANS: B
Clear communication, altruism, caring, and professional ethics are essential components of
interprofessional professionalism. Truth is faithfulness to fact or reality.
DIF: Cognitive Level: Knowledge
REF: p. 439
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
11. When looking toward the future of nursing, it is important for nurse educators to teach student
nurses that the wave of the future in nursing is in
a. bedside nursing.
b. hospice nursing and home health care.
c. advanced practice and leadership roles.
d. nurses possessing a diploma degree.
ANS: C
Advanced practice and leadership roles for nurses are the wave of the future.
DIF: Cognitive Level: Application
REF: p. 429
TOP: Step of the Nursing Process: Intervention
MSC: Client Needs: Management of Care
12. Which of the following is a nursing diagnosis associated with the effects of alteration in role
relationships within the family and work environment?
a. Sleep pattern disturbance
b. Ineffective role performance
c. Altered thought processes
d. Impaired communication
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ANS: B
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Personal role performance standards reflect personal, social, cultural, gender, institutional, and
family expectations. Standards for role performance tend to mirror differentiated practice roles as
supported by education, professional licensure, and certifications. Role performance standards
are also influenced by institutional norms and may vary depending on the work environment.
DIF: Cognitive Level: Comprehension
REF: p. 428
TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Psychosocial Integrity
13. When documenting nursing care in the client’s chart, the nurse does so accurately and honestly.
The nurse is demonstrating which essential value of professionalism in nursing?
a. Altruism
b. Integrity
c. Human dignity
d. Asepsis
ANS: B
Individual nurses identify moral integrity, purpose, and commitment as key components of
professionalism. Nurses demonstrate professionalism through accountability for the care they
provide, using recognized professional practice standards and operating within ethical and
regulatory professional frameworks.
DIF: Cognitive Level: Application
REF: p. 437
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
14. The nurse is caring for a client who has just refused to undergo an invasive procedure that could
possibly extend his life by a few months. The nurse supports the client’s decision based on which
essential value?
a. Equality
b. Truth
c. Human dignity
d. Autonomy
ANS: D
Advocacy should support client autonomy. Clients need to be in control of their own destiny,
even when the decision reached is not what you as the nurse would recommend for the client's
health and well-being.
DIF: Cognitive Level: Application
REF: p. 445
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Management of Care
15. The nurse contacts the client’s case manager to provide information about the client’s hospital
treatment plan. This is an example of which type of advocacy?
a. Role modeling
b. Educational informing
c. Collaboration
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d. Anticipatory guidance
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ANS: C
Important differences emphasize a stronger focus on primary care, meaningful use of technology,
empowering nursing leadership, shared leadership, and interdisciplinary collaboration
competencies in health care. Role modeling refers to demonstrating appropriate behaviors.
Educational informing is teaching clients about health problems and choices. Anticipatory
guidance helps the client foresee potential difficulties.
DIF: Cognitive Level: Application
REF: p. 439
TOP: Step of the Nursing Process: Planning
MSC: Client Needs: Management of Care
Chapter 23: Communicating with Other Health Professionals
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. The charge nurse is working with a group of staff nurses on a hospital unit. When delegating to
the staff nurses, the charge nurse determines that there is conflict among the group. The charge
nurse should
a. wait for the staff nurses to discuss the problems that are related to the conflict.
b. perform simultaneous activities when listening to the staff nurses.
c. present the staff nurses with documented data that is irrelevant to the conflict.
d. briefly summarize when providing the staff nurses with feedback.
ANS: D
Strategies to turn conflict into collaboration include using a brief summary to provide feedback,
recognizing and confronting disruptive behaviors by taking the initiative to discuss problems,
using active listening skills (refraining from simultaneous activities that interrupt
communication), and presenting documented data relevant to the issue.
DIF: Cognitive Level: Application
REF: pp. 450-451
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. Which of the following is true about the relationship between physicians and nurses?
a. Only the physician is responsible for fostering good physician-client
communication.
b. The physician and nurse should not engage in open dialogue.
c. The relationship between the physician and the nurse remains an evolving process.
d. Few nurses encounter problems in the physician-nurse relationship.
ANS: C
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The relationship between the physician and the nurse remains an evolving process. Changes in
the physician-nurse communication process are occurring as nurses become more empowered,
more assertive, and better educated. Nurses have a responsibility to foster good physician-client
communication. When applying principles of conflict resolution, a commitment to open dialogue
is recommended. Most nurses occasionally encounter problems in the physician-nurse
relationship.
DIF: Cognitive Level: Comprehension
REF: p. 453
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. The nurse is scheduled for a yearly evaluation by the nursing supervisor. When planning for this
meeting, the nurse should recognize the importance of
a. scheduling the evaluation during a time when anxiety level is high.
b. becoming reactive when faced with constructive criticism.
c. demonstrating defensiveness when discussing the evaluation with the supervisor.
d. listening carefully during the evaluation and paraphrasing constructive criticism.
ANS: D
When a supervisor gives constructive criticism, some type of response from the person receiving
it is indicated. To help handle constructive criticism, the nurse should listen carefully to the
criticism and then paraphrase it. The nurse should also schedule a time when she is calm,
develop a plan for dealing with similar situations, and become proactive rather than reactive. The
nurse should also discuss the facts of the situation but avoid becoming defensive.
DIF: Cognitive Level: Analysis
REF: pp. 464-465
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Psychosocial Integrity
4. When supervising an unlicensed assistive personnel (UAP), the nurse offers unwarranted
criticism that causes the UAP to feel defensive. The initial response by the UAP should be to
a. verbally defend against the unwarranted criticism.
b. allow the nurse to continue to project unwarranted criticism.
c. recognize the unwarranted criticism.
d. recognize that the unwarranted criticism must be directly related to the actual
behavior that is being criticized.
ANS: C
Recognizing a putdown or unwarranted criticism is the first step toward dealing effectively with
it. If a comment from a coworker or authority figure generates defensiveness or embarrassment,
it is likely that the comment represents more than just factual information about performance.
When faced with unwarranted criticism, the automatic response of many individuals is to
become defensive and embarrassed and in some way actually begin to feel inadequate, thus
allowing the speaker to project unwarranted feelings onto the nurse. The putdown or criticism
may be handed out because the speaker is feeling inadequate or threatened. Often it has little to
do with the actual behavior of the nurse to whom it is delivered.
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DIF: Cognitive Level: Application
REF: p. 463
TOP: Step of the Nursing Process: All phases
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MSC: Client Needs: Management of Care
5. When involved in conflict, the nurse recognizes that
a. sharing feelings about the conflict with others will increase its intensity.
b. conflict generally decreases anxiety.
c. differences in age can cause friction and make relationships less collaborative.
d. it is always appropriate to seek peer negotiation when conflict is personal in
nature.
ANS: C
Conflict behaviors can occur as a result of age differences, differences in values, philosophical
approaches to life, ways of handling problems, lifestyles, definitions of a problem, goals, or
strategies to resolve a problem. These differences cause friction and turn relationships from
collaborative to competitive. Sharing feelings about a conflict with others helps to reduce its
intensity. Generally, conflict increases anxiety. When interaction with a certain peer or peer
group stimulates anxious or angry feelings, the presence of conflict should be considered. Once it
is determined that conflict is present, a person should look for the basis of the conflict and label
it as personal or professional. If it is personal in nature, it may not be appropriate to seek peer
negotiation.
DIF: Cognitive Level: Application
REF: p. 465
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. The nurse manager is working on strategies to turn conflict into collaboration by creating a
climate in which participants view negotiation as a collaborative effort. In order to accomplish
this goal, the nurse manager works to promote
a. offering of feedback on an infrequent basis.
b. clarification of role expectations.
c. minimal participation in organizational interdisciplinary groups.
d. absence of role-modeling behaviors related to communication.
ANS: B
Strategies to turn conflict into collaboration include creating a climate in which participants view
negotiation as a collaborative effort through clarification of role expectations; soliciting and
giving feedback on a regular, periodic basis; participation in organizational interdisciplinary
groups; and modeling of communications with staff in a respectful, courteous manner.
DIF: Cognitive Level: Application
REF: p. 456
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
7. The nurse manager recognizes a need to take steps to promote conflict resolution among health
care team members on a nursing unit. In order to promote conflict resolution, the nurse manager
should
a. solicit the perspectives of only the nurses.
b. encourage manipulation among group members.
c. promote criticism of individuals within the group.
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d. depersonalize conflict situations.
ANS: D
Steps to promote conflict resolution among health care team members include depersonalization
of conflict situations. Steps to promote conflict resolution among health care team members also
include maintaining a respectful, nonpunitive atmosphere through soliciting the perspectives of
each individual, allowing group members to be assertive but not manipulative, and remembering
to criticize ideas, not people.
DIF: Cognitive Level: Application
REF: p. 464
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
8. The charge nurse is working on a unit where a nurse is frequently late for work. The charge nurse
addresses the behavior by telling the nurse, “It is necessary for you to be here on time from now
on.” This is an example of what type of constructive criticism?
a. Expressing sympathy
b. Describing the behavior
c. Stating expectations
d. Listing consequences
ANS: C
Constructive criticism includes stating expectations. An example of this is the statement: “It is
necessary for you to be here on time from now on.” Constructive criticism includes expressing
sympathy. An example of this is the statement: “I understand that things are difficult at home.”
Constructive criticism includes describing the behavior. An example of this is the statement: “But
I see that you have been late coming to work three times during this pay period.” Constructive
criticism includes listing consequences. An example of this is the statement: “If you get here on
time, we’ll all start off the shift better. If you are late again, I will have to report you to the
personnel department.”
DIF: Cognitive Level: Application
REF: p. 465
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
9. The nurse manager is working with staff members to promote conflict resolution. The nurse
manager recognizes that additional teaching is warranted when a staff member states,
a. “I will solicit the perspectives of others.”
b. “I will remember to criticize ideas, not people.”
c. “I will demonstrate manipulation when working with others.”
d. “I will avoid becoming emotional when discussing the conflict.”
ANS: C
Steps to promote conflict resolution among health care team members include maintaining a
respectful, nonpunitive atmosphere through team members demonstrating assertiveness, not
manipulation; soliciting the perspectives of others; and remembering to criticize ideas, not
people. Steps to promote conflict resolution among health care team members also include
discussion in which emotion is avoided.
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DIF: Cognitive Level: Application
REF: p. 462
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
10. When modifying barriers to professional communication, the nurse manager focuses on which of
the following?
a. Collaboration and coordination
b. Negotiation and conflict resolution
c. Coordination and networking
d. Collaboration and negotiation
ANS: B
Modification of barriers to professional communication includes negotiation and conflict
resolution. Building bridges to professional communication with colleagues involves concepts of
collaboration, coordination, and networking.
DIF: Cognitive Level: Application
REF: p. 466
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
11. A student nurse is learning about strategies to remove barriers to communication with other
professionals and how to deal with disrespectful or disruptive behaviors. The nursing instructor
recognizes that additional instruction is needed when the student nurse states which of the
following?
a. “I will learn conflict resolution skills.”
b. “I will establish common communication expectations and skills.”
c. “I will work toward creating a culture of mutual respect when working within the
health care system.”
d. “I will engage in distorted, rather than open, communication to avoid offending
others.”
ANS: D
Communication can become distorted, rather than open, when a person is concerned about
offending a more powerful individual. Strategies for dealing with disrespectful or disruptive
behaviors include: establishing common communication expectations and skills, teaching
conflict resolution skills, and creating a culture of mutual respect within the health care system.
DIF: Cognitive Level: Application
REF: p. 461
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
MULTIPLE RESPONSE
1. The nurse recruiter recognizes that collegial relationships are an important determinant of
success as professionals enter nursing practice. When interviewing candidates for nursing
careers, the nurse recruiter focuses on communication qualities that are important in developing a
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support system. Which of the following attributes best demonstrate desirable communication
qualities? (Select all that apply.)
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a.
b.
c.
d.
e.
Integrity
Internalizing
Respect for others
Dependence
A good sense of humor
ANS: A, C, E
Integrity, respect for others, dependability, a good sense of humor, and an openness to sharing
with others are communication qualities people look for in developing a support system. An
openness to sharing with others, not internalizing, helps promote collegial relationships.
Dependability, not dependence, is an interpersonal strategy to use in developing a support
system.
DIF: Cognitive Level: Application
REF: p. 465
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
Chapter 24: Communicating for Continuity of Care
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. Which of the following best describes continuity of care?
a.
It involves only clients with acute
b.
c.
d.
physical conditions.
It involves client-centered highquality care across clinical
settings.
It should focus on episodic
hospital care of seriously ill
clients.
Relational, informational, and
functional are its key
components.
ANS: B
Continuity of care (COC) is the term used to describe a multidimensional
longitudinal construct in health care that emphasizes seamless provision,
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and coordination of client-centered quality care across clinical settings.
Health care systems organized around acute, episodic care no longer suffice
as a primary service model. The complexity of contemporary health care
requires a different care process to match new health realities. There are
several reasons: demographics of the population with greater ethnic and
racial diversity, longer life spans, serious economic challenges, and health
disparities associated with social determinants of health, globalization, and
significant skilled provider shortages, most notably physicians and nurses.
Technical and scientific advances have revolutionized the prevention,
diagnosis, and treatment of acute illness. As people live longer, however,
there is a higher incidence of chronic conditions requiring an array of
supportive health care services. For these reasons, and more, focus on care
provision has shifted from the hospital to the community and a public health
emphasis. The three key features of relational, informational, and managerial
continuity provide a conceptual framework for study and application of COC
strategies.
DIF: Cognitive Level: Application REF: p. 471
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. A nurse has been employed as a staff nurse for 20 years. When comparing
her current clients to those she cared for at the beginning of her career, the
nurse finds that clients today are
a.
being discharged later.
b.
coping with being discharged
earlier.
c.
dealing with simpler medication
and treatment regimens.
d.
significantly healthier at the time
of discharge.
ANS: B
Clients are discharged earlier and sicker, often with complex medication and
treatment regimens to be followed in the community in primary care
settings.
DIF: Cognitive Level: Application REF: p. 469
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. A nursing instructor is educating a student nurse about bridging the gap
between diminishing financial support for chronic care and multifaceted
health care demands that can be long lasting. The instructor recognizes that
further teaching is warranted when the student nurse lists which of the
following as an indispensable means for accomplishing this?
a.
Self-management
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b.
c.
d.
Family involvement
Shared decision making
Family nonengagement
ANS: D
Empowering individuals and families to assume primary responsibility for
self-management of chronic illness in partnership with ongoing professional
support is a critical means of bridging the gap between diminishing financial
support for chronic care and multifaceted care demands that can last for
years. Relevant primary care strategies focus on client-centered care,
collaborative goal setting, problem solving, and coordinated follow up.
DIF: Cognitive Level: Application REF: p. 481
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
4. The nurse is caring for a client with a chronic health condition. The nurse
recognizes that in order to achieve high-quality health outcomes for this
client, which of the following should occur?
a.
Clients and families must have
consistency of personnel.
b.
Clients and families must have
irresponsible relationships.
c.
Clients and families should be
provided with vague information.
d.
Ongoing collaborative support
from coordinated health services
is discouraged.
ANS: A
Consistency of personnel over time allows clients and the professional team
to share a stronger investment in achieving personalized, high-quality health
outcomes. Providers and clients learn to know, value, and respect each other.
DIF: Cognitive Level: Application REF: p. 475
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
5. The nurse is caring for a client who will be transferred from the hospital unit
to an acute rehabilitation facility. In order to ensure continuity of care for the
client, the nurse should
a.
manage continuity through a
rigid approach.
b.
communicate infrequently with
the health care team.
c.
use a shared management plan
when providing health services.
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prohibit sharing information
about the client in order to abide
by HIPAA regulations.
d.
ANS: C
Continuity of care contributes to the development of:
• Increased accessibility to coordinated health care services with a
smoother flow of care from one service area to another
• Personalization of care to meet a client's changing needs across delivery
systems
• Informational data sharing of various elements of personal and medical
data electronically over time and place, which contributes to appropriate
care delivery
• Health services provided in an organized, logical, and timely manner,
using a shared management plan
DIF: Cognitive Level: Application REF: p. 470
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. A home health nurse visits a client and his spouse once per week to change
the client’s wound dressing. By visiting the client and his spouse weekly, the
nurse develops a sense of clinical responsibility and an accumulated
knowledge of the client and spouse’s personal and medical circumstances.
This situation describes which component of continuity of care (COC)?
a.
Internal continuity
b.
Relational continuity
c.
Management continuity
d.
Informational continuity
ANS: B
Relational continuity refers to the interpersonal elements of the COC model
across time and care settings. The term applies to nurse client/family
relationships, team relationships, and relationships between health system
providers and community-based supports. The stronger the relationships, the
greater are the potential for quality-coordinated care. Respect for client and
family values, beliefs, knowledge, cultural background, and preferences are
fundamental aspects of client-centered relational continuity. Trusting
relationships with a primary provider or “medical home” health care team
gives clients confidence that their care needs will be consistently met.
DIF: Cognitive Level: Application REF: p. 470
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
7. The nurse demonstrates understanding of continuity of care (COC) when
doing which of the following?
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a.
b.
c.
d.
Providing care in an untimely
manner
Utilizing management plans that
are inconsistent
Encouraging a longitudinal
construct in health care
Demonstrating inflexibility when
managing the client’s care
ANS: C
COC is the term used to describe a multidimensional longitudinal construct in
health care that emphasizes seamless provision and coordination of clientcentered high-quality care across clinical settings. COC operates across three
dimensions: (1) relational, (2) informational, and (3) management continuity.
These dimensions are interdependent, essential components of client care.
DIF: Cognitive Level: Application REF: p. 470
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
8. The nurse is teaching at a community center about how the focus on care
provision has shifted from the hospital to the community and a public health
focus. The nurse teaches the community members that health care systems
organized around acute, episodic care no longer suffice as a primary service
model due to the complexity of contemporary health care, which requires a
different care process to match new health realities. The nurse lists which of
the following reasons for this?
a.
Decreased ethnic and racial
diversity
b.
Overall shorter life spans
secondary to superinfections
c.
Oversupply of highly skilled
physicians and registered nurses
d.
Higher incidence of chronic
health conditions
ANS: D
Health care systems organized around acute, episodic care no longer suffice
as a primary service model. The complexity of contemporary health care
requires a different care process to match new health realities. There are
several reasons: demographics of the population with greater ethnic and
racial diversity, longer life spans, serious economic challenges, and health
disparities associated with social determinants of health, globalization, and
significant skilled provider shortages, most notably physicians and nurses.
Technical and scientific advances have revolutionized the prevention and
diagnosis and treatment of acute illness. As people live longer, however,
there is a higher incidence of chronic conditions requiring an array of
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supportive health care services. For these reasons, and more, focus on care
provision has shifted from the hospital to the community and a public health
focus.
DIF: Cognitive Level: Application REF: p. 470
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
9. The nurse is working within an interdisciplinary team. The nurse recognizes
that interdisciplinary teams are characterized by
a.
only formal interactions.
b.
individual problem solving.
c.
absence of overlapping of
professional roles.
d.
a common mission of working
together to resolve complex
clinical problems.
ANS: D
Team communication takes place informally and in structured formal team
meetings. Interdisciplinary team relationships take into account diverse
standards and behaviors associated with each clinical discipline, while
emphasizing a common mission of working together to resolve complex
clinical problems.
DIF: Cognitive Level: Application REF: p. 474
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
10. A staff nurse educates a nursing student about collaborative health care
teams. The staff nurse recognizes that additional teaching is warranted when
the nursing student lists which of the following as a characteristic of a
collaborative health care team?
a.
They are composed of a single
health care discipline in order to
maintain cost effectiveness.
b.
They are broadly classified as
multidisciplinary,
interdisciplinary, and
transdisciplinary teams.
c.
Two or more skilled clinical
practitioners will combine efforts
in providing care.
d.
There is an expectation that care
will be provided collaboratively.
ANS: B —> A??
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Collaborative health care teams are broadly classified as multidisciplinary,
interdisciplinary, and transdisciplinary teams, with the expectation that care
will be provided through the combined collaborative efforts of two or more
skilled clinical practitioners.
DIF: Cognitive Level: Application REF: p. 474
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
11. A client asks a nurse to explain the Affordable Care Act. When explaining it to
the client, the nurse tells the client
a.
b.
c.
d.
it will begin in the year 2018.
it is state legislation for health
care.
it emphasizes disease promotion
and health prevention.
it provides new consumer
protections.
ANS: D
In 2010, passage of the Affordable Care Act brought unprecedented attention
to the debate on how to best transform the nation’s health care system. This
historic federal legislation mandates increased access to affordable care,
emphasizing the importance of disease prevention and health promotion in
primary care settings and providing new consumer protections.
DIF: Cognitive Level: Application REF: p. 470
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
12. The nurse recognizes that a potential barrier to effective team
communication includes which of the following?
a.
Team role clarity
b.
Lack of territoriality
c.
Professional rivalries
d.
Transparent job responsibilities
ANS: C
Team role confusion (not clarity), fueled by professional rivalries, territoriality
(not lack of territoriality), and lack of clarification about job responsibilities
(not transparent job responsibilities, is a potential barrier to effective team
communication.
DIF: Cognitive Level: Application REF: p. 477
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
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13. The nurse recognizes that a characteristic of effective team collaboration
includes which of the following?
a.
It promotes inclusion of the client
and family.
It increases fragmentation of
client care.
It discourages synergistic
creativity among professionals.
Its goal is to duplicate efforts to
promote safe, high-quality care.
b.
c.
d.
ANS: A
Shared goals are an essential product of effective team collaboration. The
client and family should be team members involved in determining, refining,
and updating goals. Their inclusion as a collaborative team member allows
for a more realistic assessment of a client’s needs, preferences, resources,
and personal goals. They can provide important input into the development
and evaluation of care and can sensitize providers to realistic needs and
priorities.
DIF: Cognitive Level: Application REF: p. 476
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
14. When working on a hospital unit, the nurse should begin the discharge
planning process at which time?
a.
b.
c.
d.
With a careful review of initial
admission data.
Within 24 hours of the hospital
admission.
Just prior to the client’s hospital
admission.
Immediately before the client is
discharged.
ANS: A
A complex discharge planning process begins with a careful review of initial
admission data and continues as a thread with each subsequent review.
Starting early in the hospitalization allows time for clients and families to
become physically and emotionally prepared for transition and to have
needed supports available postdischarge.
DIF: Cognitive Level: Application REF: p. 482
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
15. To build relational continuity with each client, the nurse strives for
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a.
b.
c.
d.
the use of data to tailor current
treatment and care to each
client’s evidenced needs.
accurate record sharing and
technology to allow real-time
communication exchanges
between providers and with
clients in remote sites.
a consistent, coherent care
management approach that can
be flexibly adjusted as client
needs change.
a therapeutic relationship with a
practitioner that spans more than
one episode of care and leads, in
the practitioner, to a sense of
clinical responsibility and an
accumulated knowledge of the
client's personal and medical
circumstances
ANS: D
Relational continuity is "a therapeutic relationship with a practitioner that
spans more than one episode of care and leads, in the practitioner, to a
sense of clinical responsibility and an accumulated knowledge of the client's
personal and medical circumstances." Frequent team communication about
all aspects of care helps ensure relational continuity among treatment
teams. Informational continuity refers to the use of data to tailor current
treatment and care to each client’s evidenced needs. The concept includes
accurate record sharing and technology that allows real-time communication
exchanges between providers and with clients in remote sites. It is a primary
communication vehicle during care transitions and is used to help clients and
families make high-quality client care decisions. Management continuity
refers to a consistent, coherent care management approach that can be
flexibly adjusted as client needs change. Care coordination and case
management have emerged as significant methodologies associated with
management continuity.
DIF: Cognitive Level: Application REF: p. 470
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
16. A nurse manager educates a group of staff nurses about primary care. Which
of the following should the nurse manager list as a key feature of primary
care?
a.
It lacks the characteristic of
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b.
c.
d.
person centeredness.
It functions as the final contact
point for common health care
problems.
The focus is on comprehensive
care, which can meet many client
needs without referral.
The underlying goal is to offer a
highly depersonalized form of
care related to a stronger
knowledge about individual
health care needs and responses
over time.
ANS: C
Clients are considered active agents in a dynamic health care delivery
process. The expectation is that most clients will be able to self-manage the
care of their chronic health conditions in the community, with coordinated,
readily accessible health care network supports available in primary care
settings. Key features of primary care include:
• Person centeredness, with sustained continuity of relationships between
provider and client
• Functions as a first contact point with easy access services for common
health care problems
• Comprehensive care, which can meet many client needs without referral
• A highly personalized form of care related to a stronger knowledge about
individual health care needs and responses over time
DIF: Cognitive Level: Application REF: p. 471
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
MULTIPLE RESPONSE
1. A nursing instructor educates a class of student nurses about informational
continuity. The nursing instructor lists which of the following as
characteristics of informational continuity? (Select all that apply.)
a.
It allows for the same client
information to be available to
providers throughout the health
care system.
b.
It allows for specific information
to follow the client from primary
to secondary care settings, but
not vice versa.
c.
It promotes interrupted flow of
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d.
e.
data and clinical impressions
between health care providers
and agencies.
Its purpose is to provide
continuously coordinated, highquality care.
It refers to data exchanges
among providers and provider
systems and between providers
and clients.
ANS: A, D, E
Informational continuity refers to data exchanges among providers and
provider systems and between providers and clients for the purpose of
providing continuously coordinated, high-quality care. Instant electronic
transmission of data "links provider to provider, and health care event to
health care event." Ideally there is an uninterrupted flow of data and clinical
impressions between health care providers and agencies, with clients and
their families, over time and space. Specific information follows the client
from primary to secondary care settings and vice versa. The same client
information is available to providers throughout the health care system.
DIF: Cognitive Level: Application REF: pp. 479-480
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. The nurse manager conducts an in-service for staff nurses about the
importance of client-centered care. When educating staff nurses about
characteristics of client-centered care, the nurse manager lists which of the
following characteristics? (Select all that apply.)
a.
It promotes dependence within
clients.
b.
It supports allowing the client
time for questions.
c.
It considers whom information
should be provided to.
d.
It respects the amount of
information desired by clients.
e.
It encourages providing clients
with sufficient information.
ANS: B, C, D, E
Clients should be key informants, active negotiators, final decision makers,
and engaged participants in evaluating treatment outcomes. They need to
be actively involved in defining and updating realistic treatment goals. Client
centeredness is evidenced in a partnership characterized by mutual valuing
and safeguarding of the legitimate interests of the provider and the client in
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creating and managing health care decisions.
Joint decision making is a key element. The decision-making process starts
with providing each client with sufficient information, tailored to his or her
unique circumstances, to make an informed decision. Information should be
relevant to each client's diagnosis, treatments, and treatment options. The
first question to consider is, “What essential information does this client need
to have in order to make an informed decision?” Some clients value knowing
as much as possible; others want just the basic facts. Another may need to
have essential information developed in steps and spread over several
encounters to allow for better processing and formulation of related
questions. Cultural norms can dictate levels of information and to whom the
information should be given.
DIF: Cognitive Level: Application REF: pp. 474-475
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
Chapter 25: Documentation in an Electronic Era
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. The process of obtaining, organizing, and conveying client health information to others in print
or electronic format is referred to as
a. narration.
b. documentation.
c. care coordination.
d. order entry.
ANS: B
The process of obtaining, organizing, and conveying client health information to others in print
or electronic format is referred to as documentation.
DIF: Cognitive Level: Application
REF: p. 492
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. One major advantage of an electronic health information technology system is
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a.
b.
c.
d.
lack of integration.
accessibility of health records.
it is not easily transferable.
it consists of imaging files that allow for delayed access.
ANS: B
Advantages of an electronic health information technology system include that it is an integrated,
accessible electronic repository of client data with easy access by a variety of health care
providers for exchange of information. It contains and records changes in:
Updated Problem list
Hx; Dx; VS; PE data
Medication list
Allergy list (crosschecks for drug-drug allergy problems and sends “ALERTS” to providers)
Imaging files with real-time access at the point of care
DIF: Cognitive Level: Knowledge
REF: p. 494
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. Which of the following is a disadvantage of computerized charting?
a. Ability to aggregate data
b. Improved access to health record
c. Standardized charting
d. Preset activities that can be coded
ANS: C
A major drawback for nursing is that use of computerized documentation systems based on
medical code numbers often forces nurses to use classification systems designed to describe
medical practice instead of describing nursing assessment and care of clients. With this method
of charting, the richness of the nursing care provided often goes undocumented. Ability to
aggregate data, improved access to health record, and preset activities that can be coded are
advantages of computerized charting.
DIF: Cognitive Level: Knowledge
REF: p. 506
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
4. The nurse is caring for a client who is recovering from an appendectomy. Which of the following
coding systems should the nurse use for documenting changing of the client’s postoperative
abdominal dressing?
a. Nursing outcomes classification (NOC)
b. Diagnostic-related groups
c. Nursing intervention classification
d. North American Nursing Diagnosis (NANDA)
ANS: C
The nursing intervention classification organizes nursing interventions under domains. NOC is
used to classify outcomes. Diagnostic-related groups code for diagnostic procedures. NANDA
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describes nursing diagnoses.
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DIF: Cognitive Level: Application
REF: p. 505
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Management of Care
5. The nursing diagnosis for a client is immobility related to a stroke. Which classification system
can be readily used with this diagnosis?
a. Omaha system of client problems
b. Clinical pathways
c. Nursing intervention classification
d. International classification of disease (ICD)
ANS: C
The nursing intervention classification organizes nursing interventions under domains. The
Omaha classification system is used in health departments and home health agencies. Clinical
pathways are standards of practice protocols. ICD describes medical practice.
DIF: Cognitive Level: Analysis
REF: p. 505
TOP: Step of the Nursing Process: Diagnosis
MSC: Client Needs: Management of Care
6. A client is 3 days postoperative from gallbladder surgery secondary to gallstones. Domain:
Physiological. Class: Fluid and electrolyte balance. Activity: Check intravenous fluid rate intake
every hour. Which of the following nursing coding systems is represented in this situation?
a. North American Nursing Diagnosis (NANDA)
b. Nursing intervention classification
c. Nursing outcome classification
d. Omaha system of client problems
ANS: B
The nursing intervention classification identifies nursing interventions that are classified under
domains and classes. NANDA is a classification of nursing diagnoses. Nursing outcome
classification identifies and classifies nursing-sensitive outcomes of client care. The Omaha
system classifies problems under four levels: (1) major domains, (2) specific problems, (3)
modifiers, and (4) signs and symptoms.
DIF: Cognitive Level: Analysis
REF: p. 505
TOP: Step of the Nursing Process: Interventions
MSC: Client Needs: Management of Care
7. All of the following are true about electronic records except
a. they are portable.
b. they are less durable than paper charting.
c. they are easily transferable.
d. they are more durable than paper charting.
ANS: B
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Electronic records are more durable than paper charting and are portable. They are easily
transferable.
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DIF: Cognitive Level: Knowledge
REF: p. 496
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
8. Review the charting sample and determine which documentation error occurred.
a.
b.
c.
d.
1000: Hygienic care given
1100: Complaint of leg pain
1300: Appetite good, resting comfortably
Recording on the wrong chart
Failure to document an intervention
Failure to document a discontinued medication
Failure to record outcome of an intervention
ANS: B
The nurse failed to document an intervention for the client’s complaint of leg pain. The
interventions are actions that nurses perform in settings relevant to illness prevention, illness
treatment, and health promotion. There is no evidence the nurse has recorded on the wrong chart.
There is no evidence the nurse has failed to document a discontinued medication. The nurse has
recorded the outcome of an intervention by stating the client has a good appetite and is resting
comfortably.
DIF: Cognitive Level: Application
REF: pp. 501-502
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
9. Which of the following is a computer charting system related to predicting client outcomes in
home health care?
a. EHR
b. OASIS
c. NANDA
d. HIPAA
ANS: B
Beginning in 1998, home care agencies phased in a new requirement to complete a functional
health assessment on all Medicare clients before they begin care. The results of the assessment
feed into a standardized database. The Health Care Financing Administration (HCFA) developed
the Outcome and Assessment Information Set (OASIS) assessment for the purpose of describing
home care clients, developing outcome benchmarks, and providing feedback regarding quality of
care to home health agencies. The OASIS assessment is required for home health agencies to
receive reimbursement for the care provided to Medicare recipients. The acronym EHR stands
for electronic health record. NANDA stands for North American Nursing Diagnosis. HIPAA is
the Health Insurance Portability and Accountability Act.
DIF: Cognitive Level: Knowledge
REF: p. 507
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
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10. Which classification system is a comprehensive practice, documentation, and information
management tool?
a. NANDA
b. NIC
c. NOC
d. Omaha system
ANS: D
The Omaha System is a comprehensive practice, documentation, and information management
tool.
DIF: Cognitive Level: Knowledge
REF: pp. 505-506
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
11. When documenting client care, the nurse recognizes that which of the following is true about
documentation of care?
a. Every nurse should anticipate having clients’ records subpoenaed at some time
during his or her nursing career.
b. There is a need for quicker documentation that does not reflect the nursing process.
c. The legal assumption is that care was given even if it is not documented.
d. Any method of documentation that provides comprehensive, factual information is
legally unacceptable.
ANS: A
Every nurse should anticipate having clients’ records subpoenaed at some time during his or her
nursing career. Management literature emphasizes the need for quicker documentation that still
reflects the nursing process. The legal assumption is that the care was not given unless it is
documented in the client’s record. Any method of documentation that provides comprehensive,
factual information is legally acceptable.
DIF: Cognitive Level: Application
REF: p. 500
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
12. A client slipped and fell in the bathroom. When filling out an incident report, the nurse should
a. record complete, pertinent health information.
b. write about the incident report in the client record.
c. store the incident report in the client record.
d. make untimely entries.
ANS: A
A mistake to avoid is failing to record complete, pertinent health information. Other mistakes to
avoid include making untimely entries and writing about mistakes or incident reports in the client
record. Incident reports are stored separately.
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DIF: Cognitive Level: Application
REF: p. 501
TOP: Step of the Nursing Process: Implementation MSC:
Client Needs: Management of Care
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MULTIPLE RESPONSE
1. The nurse recognizes which of the following as a true statement about a nursing classification
system? (Select all that apply.)
a. It provides a standard language for nursing care.
b. It promotes visibility and defines professional practice of nursing contributions to
client care.
c. It lacks standardized terminologies that promote best practices within nursing.
d. It has not been thoroughly incorporated into many agencies’ electronic clinical
records.
e. It provides a common language for nursing care.
ANS: A, B, D, E
Nursing classification systems provide a standard and common language for nursing care so that
nursing contributions to client care become visible and define professional practice. Standardized
terminologies allow nursing research to explore nursing interventions and outcomes for common
problems to identify “best practices.” The ANA says that standards for terminology are an
essential requirement for a computer-based patient record. Standardized nursing languages need
to convince the business and medical interests managing health care agencies of the need to
incorporate nursing classification codes as part of their information technology systems. The
greatest problem has been that nursing classifications have not been thoroughly incorporated into
many agencies’ electronic clinical records.
DIF: Cognitive Level: Analysis
REF: p. 506
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. When completing documentation on each client, the nurse recognizes that documentation serves
what purposes? (Select all that apply.)
a. It communicates to others whether or not care was received.
b. It conveys pertinent information about the client’s condition and response to
treatment interventions.
c. It substantiates the quality of care by showing adherence to care standards.
d. It provides evidence for reimbursement.
e. It serves as a source of data that can be compiled or aggregated and then analyzed
to establish “best practice” interventions.
f. It is not a source for communicating care to others due to HIPAA rules and
regulations.
ANS: A, B, C, D, E
Documentation serves five purposes:
•
It communicates to others care received or not received.
•
It conveys pertinent information about the client's condition and response to treatment
interventions.
•
It substantiates the quality of care by showing adherence to care standards.
•
It provides evidence for reimbursement.
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•
It serves as source of data that can be compiled or aggregated and then analyzed to
establish “best practice” interventions. This includes electronic data, which can be aggregated
to monitor outcomes of care processes for quality improvement, a QSEN competency.
DIF: Cognitive Level: Knowledge
REF: p. 492
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
Chapter 26: Communicating at the Point of Care: Application of
eHealth Information Technologies
Arnold: Interpersonal Relationships, 7th Edition
MULTIPLE CHOICE
1. When working on a hospital unit, the nurse uses a wireless handheld
computer. The nurse recognizes that an advantage of using a wireless
handheld computer is
a.
the nurse cannot view the entire
page of client information.
b.
it can be used at the point of
care.
c.
it has a long learning curve.
d.
it poses potential threats to the
client’s legal privacy rights.
ANS: B
An advantage to using wireless handheld computers is that they are easily
portable and can be used at the point of care (e.g., at client’s bedside, in the
home). Disadvantages to using wireless handheld computers include the
nurse not being able to view the entire page of client information, a long
learning curve, and the potential threat to the client’s legal privacy rights.
DIF: Cognitive Level: Application REF: p. 509
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. When working on a hospital unit, the nurse uses a cellular telephone as an
aid to giving client care. When using a cellular telephone, the nurse
recognizes that a barrier to this type of technology is
a.
cellular telephones lead to less
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b.
c.
d.
productivity.
cellular telephones can lead to a
higher rate of hospital errors.
some hospitals prohibit using
cellular telephones.
cellular telephones complicate
information retrieval at the point
of care.
ANS: C
Although just about every nursing student has seen or used a wireless or
cellular telephone, not everyone has used them as an aid to giving client
care. There are still hospitals that prohibit nurses from using cell phones,
even though studies show these devices can save time, decrease errors, and
simplify information retrieval at the point of care. Nursing is just beginning to
deal with guidelines. Ethically, you do not use electronic devices in your
workplace for personal, nonprofessional use. All information needs to be
HIPAA secure.
DIF: Cognitive Level: Application REF: p. 512
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
3. When working on a hospital unit, the nurses use a voice communication
system that uses the existing wireless network to support instant voice
communication and messaging among staff within the agency. Using this
device allows nurses to connect to the telephone system and to access other
users of the system through a small, one-button, voice-access, lightweight
badge. This device is known as
a.
a PDA.
b.
Vocera.
c.
a smartphone.
d.
telehealth.
ANS: B
Voice communication systems use wearable, hands-free devices that use the
existing wireless network to support instant voice communication and
messaging among staff within an agency. The nurse wears a small,
lightweight badge that permits one-button voice access to other users of the
system. It also will connect to the telephone system. One example is Vocera.
It is said to reduce the time for key communications, such as looking for the
medication keys, looking for others (a 45% reduction), paging doctors, or
walking to the nursing station telephone (a 25% reduction). Nurses report
that voice-activated communication facilitates communication, results in
fewer interruptions, promotes better continuity of care, and improves their
workflow. Personal digital assistants (PDAs) are handheld electronic devices
that may contain multiple databases, possibly including a language
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translator for use when interviewing a patient from another culture.
Smartphones represent the convergence of cellular mobile phones and
mobile computers. These devices, such as the Blackberry, have three
functions. They enable one to download and access PDA-type information
resources, provide Internet access to client information [new lab results or
physician orders], and make and receive telephone calls or instant
messages. Telehealth provides live, real-time audio and visual transmissions
from one care provider to another or to a client. This technology is hailed as
a boon to rural practitioners, facilitating long-distance consultations by
expert specialists. Telehealth nursing communicates monitoring data to the
nurse from the client.
DIF: Cognitive Level: Application REF: p. 515
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
4. When caring for a client who is at risk for falls, the nurse recognizes that a
system that communicates whether the client falls and does not get up via
sensors embedded in the hospital room is referred to as
a.
telecare.
b.
health information technology.
c.
radio frequency identity chips.
d.
a personal digital assistant.
ANS: A
Telecare refers to telemetry that communicates client vital signs, monitors
whether nurses wash hands, or signals if a client falls and does not get up via
sensors embedded in the hospital room or client's house. Families in America
and England are using such sensors placed throughout the client's home to
monitor for potential problems such as stove burners left on, doors left open,
a too cold house, or a client crisis, such as an epileptic seizure. In the
literature, these are referred to as Smart Rooms, a form of automated
medical technology.
DIF: Cognitive Level: Knowledge REF: p. 514
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
5. The nurse is teaching a group of nursing students about an umbrella term for
services that use communications technology, defined as any real-time
interactive use of the Internet for delivery of health care from a distance
using telecommunications technologies. This term is known as all of the
following except
a.
telehealth.
b.
telenursing.
c.
telemetry.
d.
telemedicine.
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ANS: C
Telehealth is also called telemedicine, telenursing, or eHealth (in England). It
is an umbrella term for services that use communications technology,
defined as any real-time interactive use of the Internet for delivery of health
care from a distance using telecommunications technologies.
DIF: Cognitive Level: Knowledge REF: p. 514
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
6. Which of the following is true about electronic mail communication?
a.
Most physicians use e-mail to
b.
c.
d.
schedule appointments.
E-mail is a means of ensuring
confidentiality.
Physicians expressed concerns
about lack of income generation.
Paper copies can be eliminated.
ANS: C
E-mail can be a convenient, rapid, inexpensive method of communicating
between providers and clients. Yet, while most clients express a desire to
communicate with their health care providers via e-mail, only about 72% of
physicians in large medical centers reported using this method of
communication. Barriers include concern about lack of income generation,
confidentiality, malpractice, and time factors. Office nurses use e-mail for
scheduling appointments, posting test results, providing prescription refills,
and other health reminders. Nurses also use e-mail for education or follow-up
—for example in tracking the response of clients who are on new medication,
instead of waiting until their next office appointment. AMA guidelines
suggest that electronic or paper copies be made of e-mail messages sent to
clients.
DIF: Cognitive Level: Comprehension
REF:
TOP: Step of the Nursing Process: All phases
p. 517
MSC: Client Needs: Management of Care
7. A nursing instructor educates a student nurse about standards of effective
communication. The nursing instructor recognizes that additional teaching is
warranted when the student nurse lists which of the following as a standard
of effective communication?
a.
Clear
b.
Timely
c.
Lengthy
d.
Complete
ANS: C
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Standards of effective communication include communication that is
complete, clear, brief (not lengthy), and timely.
DIF: Cognitive Level: Application REF: p. 511
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
8. The nurse is teaching a class on stroke prevention. Which of the following
statements is accurate about studies conducted on telehealth decisionmaking and diagnosing of strokes?
a.
Several studies show telehealth
decision making and diagnosing
of strokes are just as effective
and may be more cost effective.
b.
Studies conducted on telehealth
decision making and diagnosing
of strokes have been
inconclusive.
c.
Studies show telehealth decision
making and diagnosing of strokes
are less effective and less cost
effective.
d.
Several studies show telehealth
decision making and diagnosing
of strokes are just as effective but
less cost effective.
ANS: A
Several studies show telehealth decision making and diagnosing of strokes
are just as effective and may be more cost effective.
DIF: Cognitive Level: Application REF: p. 514
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
9. The nurse is using a personal digital assistant (PDA) to store client
assessment data. When using a PDA, the nurse recognizes that the PDA
a.
is unable to recognize the nurse’s
handwriting.
b.
can provide language translation.
c.
stores only references for nursing
and drug information.
d.
cannot be used in client’s rooms
due to HIPPA regulations.
ANS: B
Personal digital assistant (PDA) is a generic term for any of several brands of
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small, handheld computerized electronic devices that fit in the palm of the
nurse's hand. PDA apps can check for drug interactions, calculate dosages,
analyze laboratory results, schedule procedures, order prescriptions, serve as
a dictionary, or provide language translation, among other functions. It is
easy to download reference sources, such as the latest medication
information or disease treatment protocols. PDAs can be taken to wherever
the client is located. Most nurses seem to prefer use of smartphones, which
do all of the above but also make phone calls.
DIF: Cognitive Level: Application REF: p. 512
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
10. Which of the following best describes a laptop computer?
a.
It is less powerful than a tablet.
b.
It should not be taken into a
c.
d.
client’s home.
It is used to chart and transmit a
client’s care.
It does not allow for information
to be transmitted in a wireless
fashion.
ANS: C
Laptop computers are used to chart and transmit a client’s care. Laptop
computers are more powerful than tablets yet both are still small and
portable enough to be taken into the client’s home. If a devise has Internet
access, information can be sent or nursing documentation completed.
DIF: Cognitive Level: Application REF: p. 513
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
11. The nurse uses an electronic information technology-based system that is
designed to improve clinical decision making to enhance client care and
safety. This system is referred to as a
a.
personal digital assistant.
b.
handheld wireless device.
c.
point of care information and
documentation system.
d.
computerized clinical decision
support system.
ANS: D
An important asset of HIT adoption is the provision of a computerized clinical
decision support system, which is referred to as CDS. A CDS is defined as an
electronic information technology-based system designed to improve clinical
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decision making to enhance client care and safety. Personal digital assistant
(PDA) is a generic term for any of several brands of small, handheld
computerized electronic devices that fit in the palm of the nurse’s hand.
Handheld wireless devices allow continual real-time exchange of information.
Nursing practice now incorporates point of care information and
documentation, allowing continual use of updated client information and
reference material at any client location via the Internet.
DIF: Cognitive Level: Application REF: p. 515
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
12. AHRQ’s analysis of 146 studies of the impact of computer health modules on
client outcomes found that these programs
a.
failed to engage client attention.
b.
succeeded in engaging client
attention.
c.
caused a decline in client clinical
health.
d.
had no significant impact on
client outcomes.
ANS: B
AHRQ’s analysis of 146 studies of the impact of computer health modules on
client outcomes found that these programs succeeded in engaging client
attention, but more significantly they improved client clinical health.
DIF: Cognitive Level: Application REF: p. 519
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
MULTIPLE RESPONSE
1. Major transformations occurring in use of Health Information Technology
(HIT) that will greatly change traditional patterns of nursing communication
include which of the following? (Select all that apply.)
a.
Electronic health record (EHR)
b.
Centralized access to client
information
c.
Handheld wireless devices to
provide continual information
d.
Point of care information
e.
Continual real time exchange of
information
ANS: A, C, D, E
Major transformations are occurring in use of HIT that will greatly change
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traditional patterns of nursing communication: EHR and accompanying
ordering and taxonomy; decentralized access to client information at the
point of care; and handheld wireless devices allowing continual real-time
exchange of information. A major transformation occurring in the use of HIT
is decentralized access to client information at the point of care.
DIF: Cognitive Level: Knowledge REF: p. 511
TOP: Step of the Nursing Process: All phases
MSC: Client Needs: Management of Care
2. Advantages of using wireless handheld computers include which of the
following? (Select all that apply.)
a.
b.
c.
d.
e.
Portability
Quick charting
Learning curve
Quick access to records
Small screen
ANS: A, B, D
Wireless handheld computers are easily portable, allow quick charting, and
permit quick access to client records. There may be a long learning curve
until the person becomes familiar with use. The small screen does not allow
the user to view the entire page of information.
DIF: Cognitive Level: Knowledge REF: p. 512
TOP: Client Needs: Management of Care
MSC: Step of the Nursing Process: All phases
3. A group of clients is signing up for a Telehealth company called ISelectMD.
The nurse educates them about ISelectMD by telling them which of the
following? (Select all that apply.)
a.
The employer’s health insurance
charges a minimal additional
health premium fee monthly.
b.
Each employee has 24/7 access
to a physician via Telemedicine
by signing onto a website and
entering his symptoms, and
paying a “visit” fee.
c.
A follow-up call is made 2 days
later to determine whether the
health issue was resolved.
d.
The physician “on call” reviews
client’s medical history and
current symptoms, makes a
diagnosis, and e-mails in a
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prescription, if needed.
Minor conditions such as urinary
tract infections or respiratory
illness can be treated in this
remote technology fashion.
Acute conditions such as chest
pain or deep vein thrombosis can
be treated in this remote
technology fashion.
e.
f.
ANS: A, B, C, D, E
Telehealth allows experts to be accessed remotely to diagnose and
treat illness, provide preventive health care, or provide medical
consultation. It initially was used to provide care to clients in rural
areas but is now also usedin urban areas. At first it originated at
health facilities, but now Telehealth often originates from the client’s
home. The company ISelectMD is one example: the employer’s health
insurance charges a minimal additional health premium fee monthly,
and then each employee has 24/7 access to a physician via
Telemedicine by signing onto a website and entering his symptoms and
paying a “visit” fee. The physician “on call” reviews client’s medical
history and current symptoms, makes a diagnosis, and e-mails in a
prescription, if needed. A follow-up call is made 2 days later to
determine whether the health issue was resolved. Obviously, only
minor conditions suchas urinary tract infections or respiratory illness
can be treated in this remote technology fashion.
DIF: Cognitive Level: Application
REF: p. 514TOP: Step of the
Nursing Process: All phases MSC: Client
Needs: Management of Care
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