Test 4 - Communication From Fundamentals Of Success By Nugent and Vitale

a) Leaning forward is a nonverbal behavior that conveys involvement. It is a form of physical attending, which is being present to another. (CORRECT ANSWER)

b) A closed posture, avoidance of eye contact, increased muscle tension, and increased motor activity convey anxiety.

c) Piercing eye contact, increased voice volume, challenging or confrontational conversation, invasion of personal space, and inappropriate touching convey aggression, which is hostile, injurious, or destructive action or outlook..

d) Self-esteem is not reflected by leaning forward during an interview. Self-esteem is one's judgment of one's own worth, including how the person's standards and performances compare to others and to one's ideal self. A person has a positive self-esteem when one's self concept matches the ideal self.

a) This is judgmental or disapproving statement and is not constructive. The patient cannot change the past. In addition, "why" questions should be avoided because they can be interpreted as accusations, which can cause resentment and mistrust.

b) The therapeutic open-ended statement gently seeks clarification. It gives the lead to the patient to share whatever thoughts and feelings that the patient may wish to express. (CORRECT ANSWER)

c) This focuses attention away from the patient's needs and is not therapeutic.

d) The first half of the statement reflects the patient's feelings of frustration, which is appropriate. However, the second half of the statement is judgmental and imposes the nurse's standards on the patient, which is not therapeutic.

a) This open-ended statement invites the patient to communicate while focusing on the reason for seeking health care. (CORRECT ANSWER)

b) This direct question can be answered with a yes or no response.

c) This statement may discourage communication. Emphasis should be placed on promoting communication to collect important data.

d) The desire to talk and the need to talk are different issues. It is helpful if health care providers collect as much significant data as possible.

a) This response encourages the patient to explore concerns. Verbalization of concerns, validation of feelings, and patient teaching may help reduce anxiety (CORRECT ANSWER)

b) This intervention bypasses data collection. In addition, ice chips are composed of water, which is contraindicated before and after a bronchoscopy because of the risk for aspiration.

c) This response ignores both of the patient's concerns and addresses a completely different issue.

d) Fluid and food are not permitted after a bronchoscopy until the gag reflex returns.

a) This response is false reassurance. Only the wife can make this statement.
b) Although a true statement, this response negates the patient's concerns and cuts off communication.
c) This may or may not be a true statement. Only the wife can make this statement
d) The patient may be using projection to cope with the potential for impotence. This response reflects that it is acceptable to talk about sexuality and invites the patient to verbalize concerns. (CORRECT ANSWER)

a) This response will put the patient on the defensive and jeopardize the nurse-patient relationship.

b) This response will require the patient to rationalize the daughter's behavior and focuses on the information that is not significant at this time.

c) This lets the patient know that the message has been heard and moves forward to meet the need to notify a significant other of the patient's situation.

d) This provides false reassurance. Only the daughter can convey this message.

a) A confused patient does not necessarily have hearing problems. This approach is appropriate for some people with a hearing impairment

b) Confused person might interpret touch as an aggressive act and respond by being frightened or agitated.

c) Simple direct statement are messages that require minimal effort and time to decode, resulting in better understanding by the confused patient. (CORRECT ANSWER)

d) Medication is last resort. Nursing interventions can calm an upset confused patient.

a) The purposes of the opening stage of an interview are to establish rapport and orient the interviewee. A relationship is established through a process of creating goodwill and trust. The orientation focuses on explaining the purpose and nature of the interview and what is expected of the patient. (CORRECT ANSWER)

b) Not purpose of the working stage. In working stage, also called the body stage, of an interview patients communicate how they think, feel, know, and perceive in response to questions by the nurse.

c) There is no stage called the surrogate stage in an interview. Hildegard Peplau identified six roles that
d)

a) This is not necessarily helpful for a patient who is having difficulty communicating a message. This is advisable when a patient is having difficulty receiving a message, not sending a message.

b) This will not improve a patient's ability to speak. This is advisable when a patient is having difficulty receiving, not sending a message

c) This is demeaning, and may promote a low self-esteem

d) This intervention demonstrates respect and supports the patient's self-esteem. Patients who have difficulty formulating and communicating a message should be afforded ample time to complete the task without being rushed. (CORRECT ANSWER)

a) Nonverbal behavior is controlled more by the unconscious than by the conscious mind.

b) Nonverbal behavior carries more, not less weight than verbal interactions because nonverbal behavior is influenced by the unconscious.

c) Transculturally, nonverbal communication varies widely. For example, gestures, facial expressions, eye contact, and touch may reflect opposite messages among cultures and among individuals within a culture. (CORRECT ANSWER)

a) This statement avoids the patient's feelings and fails to respond to the patient's need to talk about concerns. It cuts off communication
b) This statement is therapeutic. It recognizes the patient's feelings, give the patient the permission to feel nervous, and reassures the patient that one's behavior is not unusual. This statement sets the groundwork for the next question, such as, "Let's talk a little bit about the spinal tap and the concerns you may have." (CORRECT ANSWER)

c) This is a generalization that minimizes the patient's concern and should be avoided

d) This is false reassurance, which discourages discussion of feelings and should be avoided

a) Probing questions violate the patient's privacy, may cut off communication, and are inappropriate even in a focused interview. Probing interviewing occurs when the nurse persistently attempts to obtain information even after the patient indicates an unwillingness to discuss the topic or pursues information out of curiosity, rather than because the information is significant.

b) Although clarification may be used during a focused interview to understand what the patient is saying, it is not the primary technique utilized for seeking specific information.

c) A Focused interview explores a particular topic or obtains specific information. Direct questions meet these objectives and avoid extraneous information. (CORRECT ANSWER)

d) Paraphrasing may be used during a focused interview to redirect ideas back to the patient so that the patient can verify that the nurse received the message accurately or to allow the patient to hear what was said. However, it is not a technique that obtains specific information quickly.

This is not paraphrasing (restating patient's basic message), not confrontation (a challenging statement that does not consider feelings) and not reflective technique (referring back to the basic feelings). It is an open-ended statement that invites the patient to elaborate on the expressed thoughts with more than a one or two word response.

a) Reflective technique requires active listening to identify the underlying emotional concerns or feelings contained in patient's messages. These feelings are then referred back to patients to promote a clearer understanding of what they have said. (CORRECT ANSWER)

b) Content themes are referred back to patients through paraphrasing, which is a restatement of what was said in similar words.

c) When seeking clarification the nurse can confess confusion, restate the message or ask the patient to elaborate in attempt to make the patient's message more understood.

d) Summarization reviews the significant points of discussion to reiterate or clarify information

a) Although the environment may enhance or be a barrier to communication, it does not determine the goals of communication.

b) The role of a nurse in a particular setting does not dictate the goals of communication.

c) The patient and significant others and their needs are always the focus of nursing interventions including the goals of communication. (CORRECT ANSWER)

d) Although the interviewing skills of the nurse may determine the effectiveness of communication, it does not set the goals of communication.

a) Recognizes the patient's feelings. (CORRECT ANSWER)
b) Denies patient's feelings and gives false reassurance
c) Denies patient's feelings
d) Denies patient's feelings and gives false reassurance.

a) This statement is a barrier to communication. Most information communicated by the patient can remain confidential.

b) The effective open-ended statement invites the patient to continue talking; however, it does not set up the parameters of the therapeutic relationship.

c) Personal information remains confidential even if significant other members of the health team are aware of the information. This is known as the circle of confidentiality.

d) This statement is an open, honest response and sets up the parameters of the therapeutic relationship. The nurse must be credible, that is trustworthy, reliable, caring, supportive, and honest. (CORRECT ANSWER)

a) Nonverbal communication (body language) conveys messages without words and is under less conscious control than verbal statements. When a person's words and behavior are incongruent, nonverbal behavior most likely reflects the person's true feelings. (CORRECT ANSWER)

b) Although hearing, one aspect of decoding message, is an important factor in communication process, it is unrelated to the stated proverb,.

c) Although this true statement reflects active listening, it is unrelated to the stated proverb.

d) The statement is unrelated to the state proverb. The volume of the message may or may not influence understanding of the message. The volume of a message occurs on the physiologic level, while understanding a message occurs on the cognitive level.

a) Not therapeutic. Focuses on nurse rather than patient.

b) First part minimizes loss. Second part focuses on pain experience by child, which experiences mother's grief

c) Response minimizes loss and focuses on the pain experienced by child, which may increase mother's grief.

d) First sentence communicates empathy. Second sentence focuses on feelings surrounding loss and provides opportunity for the patient to verbalize. Both of these are therapeutic (CORRECT ANSWER)

a) "Laying on of hands does not occur with personal distance. Personal space (1 1/2 to 4 feet) is effective for communicating with another. It is close enough to imply caring and is not extended to the distance that implies lack of involvement.

b) Physically caring for the patient involves inspection and touch that invades the instinctual, protective distance immediately surrounding an individual. Intimate space (physical contact to 1 1/2 feet) is characterized by body contact, visual exposure, and low-volume interactions (CORRECT ANSWER)

c) Invasive touching does not occur with social distance. Social space (4 to 12 feet) is effective for more formal interactions or group conversations.

d) Touching is not used with public distance. Public space (12 feet and beyond) is effective for communicating with groups or the community. Individuality is lost.

a) Therapeutic communication is patient-centered and goal-directed. It facilitates the exploration of the patient's thoughts and feelings and helps to establish a constructive relationship between the nurse and patient. (CORRECT ANSWER)

b) Although this is often done, there are times when the patient may ramble and need to be refocused by the nurse.

c) Although this is often done, therapeutic communication can occur at any time, such as when providing physical hygiene or performing a procedure.

d) Although this is often done, there are many times when this response would be inappropriate.

a) This is demeaning and may be viewed by the patient as aggressive behavior

b) This may or may not be effective. Although this may be helpful with the older adult whose hearing loss typically involves high-pitched sounds first, there is no reference to this patient's age or type of hearing loss.

c) This may be demeaning and ineffective because the patient may not be able to read lips

d) This focuses the patient's attention on the nurse. A hearing impaired receiver must be aware that a message is being sent before the message can be received and decoded. (CORRECT ANSWER)

a) This is an example of paraphrasing. It may be perceived as a challenging statement that may put the patient on the defensive.

b) This open-ended question reflects the patient's feelings and invites the patient to talk about concerns in more detail (CORRECT ANSWER)

c) This statement abdicates responsibility, delays a discussion about the patient's feelings, and is inappropriate.

d) This is not the best response of the options offered. Although it may at first appear appropriate because it seeks clarification, it puts words into the patient's mouth and unnecessarily escalates the situation by challenging the patient.

a) This may or may not be an accurate assumption.

b) This makes an assumption that may be erroneous

c) This patronizing response treats the patient in a condescending manner. The patient cannot calm down.

d) This response requests additional information in an attempt to clarify an unclear communication (CORRECT ANSWER)

a) Humor used inappropriately can cause anger to be increased, suppressed or repressed. Anger should be safely expressed.

b) The focus should be on patient's concern

c) Humor is an interpersonal tool and a healing strategy. It releases physical and psychic energy, enhances well-being, reduces anxiety, increases pain tolerance, and places experiences within the context of life (CORRECT ANSWER)

d) Coping strategies should not be delayed because delay increases stress and anxiety and prolongs the process.

a) This is an example of paraphrasing. It repeats contents in the patient's message in similar words or provide feedback to let the patient know whether the message was understood and to prompt further communication (CORRECT ANSWER)

b) This does not address the content or emotional theme of the patient. In addition, this probing question may be a barrier to communication.

c) This assertive, confronting, judgmental response will put the patient on the defensive and cut off communication.

d) This response is condescending, judgmental, and confrontational, which will put the patient on the defensive and inhibit further communication

a) Negates patient's concerns. Patient needs to focus on "negative" before positive. Only the future will tell if patient meets someone who cares

b) False reassurance. No way can the nurse ensure that his belief will change.

c) Example of paraphrasing, which restates the patient's message in similar words. It promotes communication (CORRECT ANSWER)

d) Unnecessary. Patient already stated his point of view.

a) There are times that the nurse must assume a dominant role; examples include when the patient is unconscious , out of touch with reality, in a crisis, or experiencing panic.

b) IN a therapeutic relationship, the focus is on the patient, not the nurse.

c) The helping relationship (interpersonal relationship, therapeutic relationship) is a personal, client-focused, goal oriented process whereby the nurse assists a person to problem solve and meet needs. (CORRECT ANSWER)

d) The purpose of a therapeutic relationship is to focus on and meet the needs of the patient, not the nurse.

a) This is an inference based on inadequate data.

b) This is an example of paraphrasing, which restates the content of the patient's message in similar words. (CORRECT ANSWER)

c) This is an example of reflective technique, which focuses on feelings

d) This is an example of an open-ended statement, which invites the patient to elaborate on the stated concern

a) This question is too direct. The husband may not be in touch with his feelings and will be unable to answer the question.

b) This response acknowledges that the patient is in a dilemma and it offers an opportunity to explore the situation. Validation and an invitation to talk provide emotional support. (CORRECT ANSWER)

c) This response focuses on the patient's needs and ignores the husband's concerns

d) This response is condescending and focuses on the patient's, not the husband's needs

a) This example is reflective technique identifies feelings, which promotes communication.
b) This example of paraphrasing restates the content of the patient's message, which promotes communication
c) This example of reflective technique focuses on feelings, which promotes communication
d) This response is FALSE REASSURANCE. It denies the patient's concerns about survival and does not invite the patient to elaborate. (CORRECT ANSWER)

a) Response abdicates nurse responsibility to explore patient's concerns immediately. It could be an erroneous assumption

b) Patient is in shock and disbelief mode of coping and would not be able to explore approaches to coping. Using the words "terrible news" may increase anxiety and hopelessness.

c) This ignores the patient's feelings and imposes the nurse's feelings into the situation.

d) Example of reflective technique. When no solutions to a problem are evident, a person becomes hopeless (despair, despondent) CORRECT ANSWER.

a) The direct question can be answered with a YES or NO response

b) The direct question elicits a minimal amount of information about only one aspect of eating.

c) This direct question focuses on just one aspect of the problem, duration.

d) This question is an example of reflective technique because it focuses on the feeling of surprise. (CORRECT ANSWER)

a) Communication includes both verbal and nonverbal messages.

b) Communication is facilitated by interviewing techniques that include attitudes, behaviors, and verbal messages. Interviewing skills promote therapeutic communication because they are patient-centered and goal-directed. (CORRECT ANSWER)

c) Assertiveness when collecting data may be perceived by the patient as aggression, which is a barrier to communication.

d) A therapeutic relationship should avoid sympathy because it implies pity. The nurse should empathize and not sympathize with patients.

a) This is not an example of FOCUSING, which centers on the key elements of the patient's message in an attempt to eliminate vagueness. It keeps a rambling conversation on target to explore the major concern.

b) This is not an example of REFLECTING, which focuses on feelings. The use of the word "feel" does not make the nurse's statement an example of reflection.

c) This is not an example of VALIDATING. Consensual validation, a form of clarification, verifies the meaning of specific words rather than the overall meaning of the message. This ensures that both patient and nurse agree on the meaning of the words used.

d) The nurse's response is an example of paraphrasing because it uses similar words to restate the patient's message. CORRECT ANSWER

a) The nurse should maintain a professional relationship with the patient. Nurses may be friendly toward but should not establish a friendship with a patient.

b) Humor with emotionally charged issues may be viewed as minimizing concerns or frivolous, and could be a barrier to communication.

c) Emotionally charged topics should be approached with respectful, sincere interactions that are accepting and nonjudgmental, which will promote further verbalizations (CORRECT ANSWER)

d) Sympathy denotes pity, which should be avoided. The nurse should empathize, not sympathize, with patient.

a) This response recognizes and reflects back the underlying feeling in the patient's message (reflecting technique). When people are in trouble they usually feel threatened or stressed. (CORRECT ANSWER)

b) This restates the patient's comment in similar words and is an example of paraphrasing, not reflection.

c) This negates the patient's concerns and shuts off communication.

d) This is not an example of reflection; it is a direct question that collects specific information

b)

a) Watzlawick;s theory indicates that all behavior has meaning, people are always behaving, and we cannot stop behaving or communicating; therefore, communication is inevitable. (CORRECT ANSWER)

b) Behavior may imply, not clearly reflect, feelings. The nurse should obtain verbal feedback from the patient regarding assumptions about behavior.

c) The face, not the hands, is the most expressive part of the body.

d) All communication, not just verbal communication, is essential for human relationships.

a) The patient is the primary source of information. When nonverbal communication reinforces the verbal message, the message reflects the true feelings of the patient because nonverbal behavior is under less conscious control than verbal statements (CORRECT ANSWER)

b) This abdicates the nurse's responsibility to others and obtains a response that is influenced by emotion and subjectivity.

c) Direct questions are too specific. Open-ended questions or pointing out the incongruence between actions and words are more effective techniques than direct questions in this situation.

d) Nonverbal behaviors, rather than verbal statements, better reflect true feelings. Actions speak louder than words!

a) Examining is not an interviewing technique.

b) Reflective technique refers to feelings implied in the content of verbal communication or in exhibited nonverbal behaviors. Patients who are crying, quiet, and withdrawn are often sad. (CORRECT ANSWER)

c) This is not an example of clarifying, which is a use of a statement to better understand a message when communication is rambling or garbled.

d) this is not an example of orienting. Reality orientation is a nursing technique used to assist patients in restoring an awareness of what is actual, authentic, or real.

a) The majority of the collection and analysis of data is conducted during the working, not orientation, phase of a therapeutic relationship.

b) The orientation phase (also called the introductory or prehelping phase) of a therapeutic relationship sets the tone for the rest of the relationship. A Rapport develops when the patient recognizes that the nurse is willing and able to help and can be trusted. (CORRECT ANSWER)

c) Problems are identified, explored and dealt with during the working, not orientation, phase of a therapeutic relationship.

d) Priority needs are identified and interventions planned and implemented during the working, not orientation, phase of a therapeutic relationship.

During the working phase of the therapeutic relationship, nursing interventions have a twofold purpose: assisting patients to explore and understand their thoughts and feelings and facilitating and supporting patient decisions and actions.

Formal or informal contracts are established during the introductory phase (orientation) and not in the working phase of a therapeutic relationship

The development of trust is the primary goal of the introductory phase, not working phase, of a therapeutic relationship. Trust is achieved through respect, concern, credibility, and reliability.

The roles of a nurse are established during the introductory phase and not in the working phase

a) This is not an immediate priority

b) Too focused and should include dietary intake for the previous day, not the day before

c) Invites the patient to expand on and develop a topic of importance that relates to the current problem. (CORRECT ANSWER)

d) Although this historical information eventually may be obtained, it is not the immediate priority.

a) "Why" statements are direct questions that tend to put the patient on the defensive and cut off communication.

b) Active listening is the use of all the senses to comprehend and appreciate the patient's verbal and nonverbal thoughts and feelings (CORRECT ANSWER)

c) Silence is passive, not active. Silence allows the patient time for quiet contemplation of what has been discussed.

d) When talking with patients, verbal and nonverbal cues are used to indicate care and concern, which promote communication.

a) Confused patients more easily understand simple words and sentences (CORRECT ANSWER)

b) This may not be understood by the confused patient.

c) A confused patient may not be able to make a decision

d) This is a threat and should be avoided when talking with patients.

a) This just ensures that the message probably reflects the true feelings of the patient.

b) Interactions, even if conducted in a professional manner, may or may not be effective.

c) Understanding is the foundation of therapeutic communication. When the nurse comprehends, appreciates and empathizes with the patient, therapeutic communication is effective. The working phase of the helping relationship can then move forward and is productive. (CORRECT ANSWER)

d) This just ensures that ideas or feelings are communicated

a) The patient, not the nurse, should direct the flow of communication.

b) Negative feelings or concerns must be addressed. Both physical and psychic energy are used when coping with stress.

c) Communication between the patient and healthcare providers is essential, particularly for obtaining subjective data and feedback. Speech, pantomime, writing, touch, and picture boards are examples of channels of transmission (CORRECT ANSWER)

d) The focus must be on the patient's present concerns before refocusing to other issues because anxiety increases if immediate concerns are not addressed.

a) This example of Focusing helps patient explore a topic of importance. The nurse selects one topic for further discussion from among several topics presented by the patient (CORRECT ANSWER)

b) Not an example of clarifying which lets the patient know that a message was unclear and seeks specific information to make the message clearer.

c) Not an example of paraphrasing which is restating the patient's message in similar words

d) Not an example of acknowledging, which is providing nonjudgmental recognition for a contribution to the conversation, a change in behavior, or an effort by the patient.

a) This probing question attempts to seek information about a topic the patient is unwilling to explore. This direct question may put the patient on the defensive and further shut off communication.

b) This judgmental statement may cut off further communication.

c) This direct question will probably elicit a response of "No" because the patient appears reluctant to talk.

d) This statement identifies a common reaction to an emotionally charged situation. It is an accepting open-ended remark that provides an opportunity for the patient to talk with the nurse (CORRECT ANSWER)

a) The first part of the statement uses a therapeutic interviewing technique of reflection, which identifies the underlying feelings of the patient and is appropriate. However, the second half of the statement is asking for an explanation, which is inappropriate. Patients often interpret "why" questions as accusations which can cause resentment and mistrust and should be avoided.

b) This is an example of therapeutic interviewing skill of an open-ended statement. It demonstrates that the nurse recognizes what the patient is going through and the broad opening encourages free verbalization by the patient. At the very least, it demonstrates caring and concern (CORRECT ANSWER).

c) This minimizes patient's feelings and is not appropriate.

d) This would not inspire confidence in the nurse. Nurses should know what is happening if care is to be comprehensive and patient-centered.