Balzer Riley: Communication in Nursing, 7th Edition Chapter 04: Understanding Each Other: Communication and Culture MULTIPLE CHOICE

Balzer Riley: Communication in Nursing, 7th Edition Chapter 04: Understanding Each Other: Communication and Culture MULTIPLE CHOICE 1. A non-Hispanic white nurse provides care to mostly Hispanic patients. It wou ...

Balzer Riley: Communication in Nursing, 7th Edition Chapter 04: Understanding Each Other: Communication and Culture MULTIPLE CHOICE 1. A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? 2. The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about delivering care to diverse clients? 3. The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client? 4. The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best? 5. The nurse is interviewing a Native American client. It is most important for the nurse to take which action? 6. The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate? 7. The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse? 8. A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective? 9. Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse? 10. Which characteristic would the nurse use to define culture? Select all that apply. Chapter 07: Warmth Test Bank MULTIPLE CHOICE 1. The nurse greets a patient who is admitted to the hospital. Which action by the nurse displays warmth and concern? 2. A nurse manager asks a colleague for advice on strategies to improve communication with staff nurses. Which response by the nurse manager’s colleague is best? 3. The nurse observes a student nurse who demonstrates nonverbal expressions that are cold and convey disinterest when caring for patients. Which statement, if made by the nurse, is best? 4. A nurse preceptor is assigned to help several graduate nurses assess their ability to convey warmth to patients. Which activity, if selected by the nurse preceptor, is best? 5. The nurse has implemented a plan to improve expression of warmth to other nurses. It is most important for the nurse to include which evaluation method? 6. A patient is irritable and complains to the nurse about difficulty sleeping last night. Which response by the nurse is most appropriate? 7. A patient reports to the nurse, “My doctor is not doing anything about my pain.” Which response by the nurse is assertive and expresses warmth? 8. Which facial feature, if displayed by the nurse, best conveys warmth? 9. The nurse cares for a patient who has metastatic cancer. Which action(s) by the nurse conveys warmth? Select all that apply. Chapter 08: Respect Test Bank MULTIPLE CHOICE 1. The nurse cares for a client who does not follow dietary recommendations for treatment of heart failure. Which statement, if made by the nurse, demonstrates respect for the client? A. “It doesn’t make any difference to me whether you decide to eat healthy or not.” B. “You will get more attention from your physician, if you follow diet restrictions.” C. “I care about you even if you are not following your dietary restrictions.” D. “Have you noticed that patients who eat healthy foods receive better health care?” ANS: C The nurse demonstrates respect by giving unconditional acceptance of the client’s ideas, feelings, and experiences without conditions. The nurse demonstrates respect with statements that convey caring; respectful statements make the client feel important and valued. The nurse is not demonstrating respect if conditions for acceptance (i.e., “more attention” or “better health care”) are required. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 94 2. The nurse is caring for a client who is diagnosed with type 1 diabetes mellitus. Which nursing action would most likely improve client compliance with the therapeutic regimen? A. Consistently ignore negative statements made by the client. B. Avoid touching the client to reduce tension and uneasiness. C. Focus on the physical aspects of care such as insulin administration. D. Listen attentively to the client’s perception of having a chronic illness. ANS: D Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is communicated by giving the client undivided attention and listening to the client’s perceptions. Other actions that demonstrate respect include appropriate contact by gently touching the client, listening to both positive and negative client statements without judgments, and giving attention to the client as a whole (body, mind, and spirit). DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 94 3. The home care nurse is assigned to make the first home visit to a new client who has been discharged from the hospital. After initial introductions the nurse should take which action to convey respect? A. Ask the client to develop a list of needs to discuss at the next visit. B. Wear a name badge that clearly identifies the home care agency. C. Provide contact information for several other clients who can serve as references. D. Tell the client that information obtained will not be shared with others. ANS: B The home care nurse can convey respect at the initial visit by wearing a name badge that clearly identifies the home care agency. Another action that conveys respect during the initial visit is to determine the client’s needs; the nurse should not wait until the next visit. In addition, the nurse must respect the client’s right to confidentiality; client contact information should not be shared with other clients. Also, the nurse should not promise to keep secrets because the nurse must use clinical judgment about shared information that might cause potential harm to the client or someone else. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 95 4. The nurse prepares to obtain a health history from a hospitalized patient. Which action by the nurse is appropriate? A. Set time limits for the interview to reduce cost. B. Avoid asking questions that may upset the patient. C. Respect the patient’s privacy by closing the door. D. Stand at the foot of the bed to maintain eye contact. ANS: C The nurse should ensure privacy before engaging in a discussion of confidential matters when obtaining a health history. The nurse should allow for adequate time for the client to discuss the health history. The nurse must be able to discuss sensitive health issues with clients; the nurse should establish rapport and respectfully discuss sensitive subjects. The nurse should avoid standing over the patient; the nurse should be at eye level with the patient. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 96 5. The nurse instructs a client who is diagnosed with hypertension about weight reduction and dietary guidelines. Which action by the nurse would most likely improve the client’s willingness to lose weight and eat healthy foods? A. Avoid interacting with the client during meals to prevent embarrassment. B. Ignore the client’s requests for foods that are high in fat or calories. C. Give genuine praise to the client for trying to improve dietary habits. D. Warn the client that individuals who are overweight will be treated differently. ANS: C Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is given when the nurse recognizes the client for efforts to improve health. The nurse who either avoids or ignores the client is demonstrating disrespectful behavior. Treating a client differently because of noncompliance is disrespectful. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 95 6. The nurse cares for elderly clients in an assisted living center. Which action by the nurse would best show respect for these clients? A. Patronize clients who share ideas or voice concerns. B. Identify health care needs by listening to the clients. C. Address the clients formally by their last name. D. Limit the clients’ opportunities to express opinions. ANS: B The nurse shows respect by listening to clients discuss ideas, concerns, or health care needs. The nurse should not belittle, judge, demean, or patronize clients; these actions are disrespectful. The nurse demonstrates respect by asking the clients their preferences for being addressed; not all elderly clients want to be called by their last names. The nurse demonstrates respect by providing opportunities for the clients to express opinions. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 94 MULTIPLE RESPONSE 7. The nurse cares for an adult client who is diagnosed with active tuberculosis. Which action, if performed by the nurse during introductions, show respect for the client? Select all that apply. Chapter 09: Genuineness Test Bank MULTIPLE CHOICE 101, 102 1. An experienced nurse is supervising a student nurse in an acute care setting. Which statement, if made by the experienced nurse, would be most appropriate to help the student nurse establish credibility with other nurses on the unit? A. “It is impossible to be credible when you are a student because you lack experience.” B. “Try to hide your feelings of inadequacy and portray a sense of confidence.” C. “Be honest with the nurses about your strengths and about areas that need improvement.” D. “It would help if you bring special treats for the nurses so that they will like you.” ANS: C Building of trust is the most important reason for being genuine; being genuine is important in gaining credibility with colleagues. An individual can be genuine and credible without extensive experience. Genuineness occurs when both verbal and nonverbal behaviors are congruent. Being liked is not equivalent to being genuine or being honest. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 103 2. Which individual is displaying thoughts or actions that are genuine? MULTIPLE RESPONSE 3. A nurse openly discusses thoughts and feelings about sexually transmitted infections with a group of college students. Which benefit(s) may occur for these college students? Select all that apply. 4. A nurse seeks to improve self-confidence when caring for hospice patients. Which action(s) would be most appropriate? Chapter 10: Empathy Test Bank MULTIPLE CHOICE 1. The nurse cares for a patient with a terminal illness. Which way would be the most therapeutic for the nurse to communicate with this patient? *2. The nurse cares for the mother of a child who died in the emergency room as a result of an accidental poisoning. Which response by the nurse is appropriate? 3. A young mother who fractured her leg is sobbing with her face hidden behind her hands. She says to the nurse, “I will not be able to work for at least 2 months. Without my job, I cannot pay my bills or take care of my baby. I am alone and do not have anyone to help me.” Which response by the nurse accurately conveys empathy? 4. The nurse cares for a patient who becomes confused and a vest restraint is applied. The nurse should take which action when notifying the patient’s family? *5. Which situation(s) would be appropriate for the nurse to communicate with empathy? Select all that apply. Chapter 11: Self-Disclosure Test Bank MULTIPLE CHOICE 1. A patient asks the nurse to make a decision for her about whether or not to continue taking hormone replacement therapy (estrogen). Which response by the nurse is most appropriate? 2. The nursing supervisor instructs a group of novice nurses about the appropriate use of self-disclosure with patients. The nursing supervisor determines that teaching was successful if the novice nurse makes which statement? 3. The nurse cares for an elderly patient in a long-term care center. Which would be inappropriate for the nurse to share with the client? A. Reminisce about birthday celebrations and inquire about the client’s traditions. B. Use high levels of intimacy to help the client feel more comfortable with the nurse. C. Establish a helping relationship based on trust by sharing a personal story with the client. D. Share with the client how meditation decreased nausea during chemotherapy treatment. ANS: B The following are recommendations for the sharing of self in a geriatric practice: 1) Self-disclosure helps the client get to know the nurse without the burden of high levels of intimacy; 2) Reminiscence is enhanced in elders when they are encouraged to share specific events (e.g., speak of personal holiday traditions and question clients about theirs); 3) Understand that the connection between nurse and patient is dynamic, and the perception of the nurse as a real person aids in establishing the helping relationship; 4) The nurse’s sharing of self may help decrease the client’s anxiety and diminish the stress of illness and treatment. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 130 4. A patient is attracted to the nurse and attempts to initiate a social relationship. It is most appropriate for the nurse to take which action? A. Encourage the client’s behavior to develop a trusting nurse-client relationship. B. Inform the charge nurse of the situation and ask for a different patient assignment. C. Tell the patient that the relationship must remain professional at all times. D. Determine if the patient can be transferred to another nursing care unit. ANS: C Attraction may occur if the client attempts to turn a professional relationship into a social relationship. Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. The nurse should tell the client that it is important for the relationship to remain professional. The nurse should not encourage the client’s behavior; attraction does not build trust in the nurse-client relationship. The nurse should attempt to talk with the patient instead of avoidance by either requesting a different patient assignment or transferring the patient to another unit. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 127 PRIORITIZING/ORDERING 5. The nurse plans to use self-disclosure to aid a mother and father in the grieving process after the death of their child. The steps of a helpful self-disclosure appear below. Arrange the steps in the correct order of use. A. Succinctly share a personal experience that is a similar grieving experience. B. Listen to the parents talk about their child and observe their movements and gestures. C. Reflect upon the parent’s statements to communicate understanding. D. Seek verification that the self-disclosure was helpful to the child’s parents. ANS: B, C, A, D The steps to successfully implement helpful self-disclosure are: 1) Actively listen to the parents’ verbal and nonverbal messages; 2) Reply with an empathic response; 3) Self-disclose for the benefit of the parents; and 4) Check to see if the empathic response and self-disclosure were effective. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 129 Chapter 12: Specificity Test Bank MULTIPLE CHOICE 1. The nurse instructs the nursing assistant to obtain temperatures on four patients and report abnormal findings immediately. Two hours later the nurse discovers that one of the patients had a fever that was not reported. The nurse is upset with the nursing assistant. Which statement, if made by the nurse, is concrete and specifically explains the nurse’s feelings? A. “I am not dissatisfied with your performance, because we all make mistakes.” B. “You must have misunderstood. I wanted to know about any elevated temperatures.” C. “I am disappointed because you did not follow my directions.” D. “You have made me so angry. Why did you not report the fever to me?” ANS: C When communicating feelings clearly and specifically, the individual must choose the descriptor that exactly conveys the intended emotion. Adding a rationale for the feeling enhances the sincerity of the message. If the emotion is one of feeling upset, the term “disappointed” is clear and specific. The descriptor “not dissatisfied” is the opposite of the feeling of “upset.” The descriptor “angry” is a much stronger feeling than “upset.” The statement “you must have misunderstood” does not convey the nurse’s feelings about the situation. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 137 2. The nurse cares for a patient who complains of back pain. Which question should the nurse ask to obtain specific information about the back pain? A. “Would you like medication for the pain?” B. “What have you been doing in the last few days?” C. “Do you have a family history of osteoporosis?” D. “What do you think caused the back pain?” ANS: D To obtain specific information, the nurse must specifically ask for it (e.g., ask the patient about possible causes for the pain). It is more appropriate for the nurse to initially ask for the patient’s perspective than about specific causes (e.g., osteoporosis or activity). The nurse should assess before taking action (e.g., offering pain medication); the intervention does not provide specific information about the back pain. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 138 3. A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate? A. “I will teach the students how to read nutrition labels.” B. “What would you like the students to learn about nutrition?” C. “The students need to know about the consequences of obesity.” D. “I will enjoy teaching the students everything I know about nutrition.” ANS: B It is important to focus on the aspects of nutrition that the teacher wants the students to know and that are most important for them. The nurse should not assume the students need to learn about nutrition labels or obesity. Comprehensive nutrition information may waste time, be irrelevant, or focus on material that is too frightening or too advanced. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 139 4. Which statement, if made by the nurse, could positively affect the course of the patient’s illness by suggestibility? A. “Breastfeeding will provide time to bond with your baby.” B. “Breastfeeding will take longer than giving your baby a bottle.” C. “You will need to be careful about taking medications while breastfeeding.” D. “Breastfeeding mothers can develop infections that are serious.” ANS: A The placebo effect is language or expectations of a nurse that positively affect the course of the patient’s illness by suggestibility. Breastfeeding does take more time, but the nurse can send a positive message (e.g., increased time for bonding). The nocebo effect can occur when a nurse sends a negative message through choice of language, words, or tone of voice that produces negative responses (e.g., breast feeding takes time, limits medication options, and causes infections). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 140 MULTIPLE RESPONSE 5. The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient’s electronic medical record. Which key point should the nurse educator include in the teaching plan? Select all that apply. A. A patient who is at high risk for falls will require more frequent documentation. B. The nurse should not use labels (e.g., good, drug-seeking, lazy) to describe patients. C. Detailed and specific documentation is only required if a malpractice suit is expected. D. Each entry by the nurse in the electronic medical record should be clear and concise. E. Documentation cannot be used to determine reimbursement for health care services. F. Exact statements (in quotations) from patients are more accurate than paraphrasing. ANS: A, B, D, F The complexity of the health problems and the level of risk posed by patients, by their condition, or by the use of medical, nursing, or other therapies dictate the detail and frequency of documentation. The higher the risk to which a particular patient is exposed, the more comprehensive, in depth, and frequent should be the nursing recordings. Effective recording shuns bias, avoiding tendencies to prejudge or label patients. Avoidance of a malpractice suit is a valid reason for documentation to be detailed and specific, but documentation should be detailed and specific for every patient. Clear, concise documentation is vital for every entry into the electronic medical record. Careful documentation affects the ability of a health care agency to be reimbursed for services. Effective documentation tends toward quantitative expression, avoiding vague generalizations. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 139, 140 Chapter 13: Asking Questions Test Bank MULTIPLE CHOICE 1. A client with metastatic cancer complains of severe, unrelieved pain even though appropriate pain medication has been prescribed. The home care nurse plans to ask the client questions to determine why the pain medication is not working. Which action would be most appropriate if the nurse doubts the client will understand the reason for asking these questions? A. Avoid asking any questions that might make the client feel uneasy or upset. B. Inform the client’s caregiver to maintain trust in the nurse-client relationship. C. Tell the client that the questions will help to determine a better plan to control the pain. D. Refrain from disclosing the reason for asking the questions until the end of the visit. ANS: C If there is any doubt as to whether the client will understand the nurse’s reasons for asking questions, the nurse should explain those reasons in advance. If clients understand the purpose, they are more likely to be open and to reveal information, rather than being guarded because they are uneasy about the nurse’s intentions. The client’s caregiver can also be informed, but it is vital that the client is informed. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 144, 145 2. A nurse is uncomfortable asking patients about their sexual practices and behaviors. It is most appropriate for the nurse to take which action? A. Avoid asking these questions unless the patient initiates a discussion on sexual behaviors. B. Practice asking these types of questions in a simulated situation with a colleague. C. Ask a nurse who is comfortable with these types of questions to interview the patient. D. Tell the patient that asking sexual questions is difficult and uncomfortable for a nurse. ANS: B To improve the ability to be at ease when asking questions in a variety of areas, the nurse may rehearse with friends or colleagues. If the nurse cannot overcome being uncomfortable with asking sexual questions, the nurse should be honest with the patient or have another nurse interview the patient. The nurse should not avoid asking questions regarding sexual behavior. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 146 3. The nurse questions a patient with hypertension before developing a teaching plan. Which question, if asked by the nurse, is most appropriate? A. “How long have you had hypertension?” B. “Are you taking any blood pressure medications?” C. “What do you know about hypertension?” D. “Do you understand why salt is bad for you?” ANS: C Open questions (e.g., “What do you know about hypertension?”) invite respondents to elaborate in whatever direction they choose. Closed questions are focused and posed to elicit specific and brief responses from clients. Questions (e.g., “Are you taking any blood pressure medications?” or “Do you understand why salt is bad for you?”) that only require a “yes” or “no” do not invite the patient to elaborate further about the experience. Questions that require a short answer (e.g., “How long have you had hypertension?”) do not provide an opportunity for the patient to elaborate further about hypertension. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 149 4. An experienced nurse supervises a novice nurse interviewing a patient. The experienced nurse should intervene if which is observed? A. The novice nurse uses simple language instead of medical terms. B. The novice nurse avoids asking the patient “why” questions. C. The novice nurse leaves the patient without providing feedback. D. The novice nurse asks mostly open-ended health-history questions. ANS: C The nurse should give patient-feedback after an interview to help the patient feel connected and respected. Patients feel left out when nurses end an interview without giving them any indication of the assessment. Informing patients of what is happening, including plans and what patients can expect, provides helpful transitions so that they can map their progress, feel included, and minimize worrying about erroneous assumptions. The nurse should use simple language, avoid “why” questions, and use mostly open-ended questions. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 149, 150 MULTIPLE RESPONSE 5. Which technique(s) should be avoided when the nurse questions patients? Select all that apply. A. Use questions that are worded clearly with words the patient understands. B. Provide a detailed explanation to introduce the rationale for the questions. C. Offer the patient options and tell the patient which option is preferred. D. Avoid asking a patient “why” by rephrasing the question if possible. E. Ask three to five questions at a time and then allow the patient to answer. ANS: B, C, E The nurse should provide a concise statement as a rationale for questioning. If the nurse offers the patient options, the nurse should allow the patient time to speak and make a decision without interruptions. The nurse should not ask a string of questions because the patient may become confused and not know what information is important or where to begin answering. The nurse should not use medical terminology, abbreviations, or medical jargon that the patient does not understand. When asking the patient questions, the nurse should refrain from using “why” by rephrasing the question so it is softer and more receivable. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 147, 148 Chapter 14: Expressing Opinions Test Bank MULTIPLE CHOICE 1. A nurse manager has set a goal to improve professional communication on the unit. The staff nurses have attended a session on how to distinguish between expressing opinions and giving advice. Which statement, if made by a staff nurse, indicates that further teaching is needed? A. “Nurses who express opinions give patients the opportunity to make choices.” B. “Patient safety is enhanced if nurses have confidence in their ability to communicate.” C. “Giving advice leads to independent decision making by patients.” D. “Expressing opinions or recommendations is an assertive behavior.” ANS: C Giving advice is a unilateral process of solving problems or making decisions for others; giving advice prevents patients from becoming independent. Assertive communication occurs when nurses express opinions or offer recommendations. Expressing opinions assists patients in their decision making and fosters independence. Having confidence in the ability to communicate can help prevent miscommunication, a significant threat to the safety of hospitalized patients. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 153 2. The nurse is a member of a quality improvement project team to improve communication when a patient is transferred to another unit. Which statement by the nurse is appropriate to demonstrate positive regard for the team members? A. “We have done an excellent job.” B. “We still have so much work to do.” C. “Most of our suggestions did not work.” D. “We won’t win a prize for our work.” ANS: A Giving specific positive feedback is another form of expressing opinions that can demonstrate an assertive communication style. Sharing positive opinions helps team members feel comfortable, share ideas, and promote creativity and teamwork. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 157 3. A new blood glucose bedside monitoring system is introduced at a staff meeting. A nurse who has previously used this system remembers that the meter would show error messages frequently. Which statement by the nurse demonstrates assertiveness? A. “Why did no one ask for my opinion? I should have been involved in this decision.” B. “This meter does not work like it should, and I refuse to use this system ever again.” C. “I had problems with this meter before, but I will use it and let you know what I think.” D. “I have experience with this system, and there were never any serious problems.” ANS: C Nurses may feel powerless if decisions are made without their input or with which they disagree. Nurses can make a choice about when to share their disagreement even if they see no choice but to comply with the decision. Voicing disagreement makes the nurse feel more authentic and assertive. Assertiveness is a matter of choice and is not necessary or appropriate in every situation. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 158 MULTIPLE RESPONSE *4. Which nurse statement(s) is/are examples of expressing opinions in an assertive way with colleagues? Select all that apply. A. “Do you think this project will help you learn about evidence-based practice?” B. “I will tell you about the evidence-based project, and you will want to help.” C. “I recently attended an evidence-based conference. Can I share the highlights?” D. “I think we should be paid because this project will save money. What do you think?” E. “I really think you should read more evidence-based journal articles.” ANS: A, C, D To avoid generating feelings of hostility or resentment, the nurse should ask colleagues if they are interested in hearing the nurse’s viewpoint. The nurse should avoid being dogmatic or using strong phrases when expressing opinions. The nurse should be tentative about offering persuasions to show consideration of others’ special circumstances. When offering an opinion, the nurse should give others a fair chance to accept or reject ideas. When expressing opinions to colleagues, the nurse should give the rationale in a responsible way; the nurse should offer a reason for his or her preferences and then turn the final decision back to the client. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 155, 156 5. A nurse who frequently corrects other staff nurses is trying to avoid making comments when it really does not matter. In which situation(s) would it be appropriate for the nurse to remain silent and not share an opinion? Select all that apply. A. A staff nurse reports a blood pressure as 110/60 but it is recorded in the chart as 114/62. B. A staff nurse takes a lunch break for 33 minutes instead of 30 minutes. C. A staff nurse gives a medication orally instead of by injection. D. A staff nurse reports no discrepancy for the narcotic count, but one is missing. E. A staff nurse does not pronounce the generic name of a medication correctly. ANS: A, B, E Nurses need to know when to express opinions and when not to share opinions and have the strength not to always be right. The nurse should not share opinions when it does not make a difference (e.g., insignificant differences in blood pressure readings, taking an extra 3 minutes for lunch, mispronunciation of medical terms with colleagues). Opinions should be expressed if patient safety is involved (e.g., administering medication by the wrong route) or there are legal ramifications (e.g., a controlled substance is missing). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 157 Chapter 15: Humor Test Bank MULTIPLE CHOICE 1. A nurse instructs colleagues about the use of humor with patients. Which statement, if made by a colleague, indicates that the teaching is effective? A. “Telling a joke is the best way to use humor.” B. “Humor can help patients to be less afraid.” C. “I should avoid humor when giving a bath.” D. “Patients will not talk to me if I use humor.” ANS: B Humor improves the patient’s ability to cope with stress and fear. Droll humor is more effective than formal jokes. Humor may help to put a patient at ease during a bath. Humor invites interaction. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 161 2. The nurse supervises the care of residents in an assisted living center. The nurse should intervene if which is observed? A. A nursing assistant remains silent when a resident tells a demeaning joke. B. A nursing assistant and resident laugh together while watching television. C. Two nursing assistants laugh at themselves after spilling a pitcher of water. D. A nursing assistant makes a joke about a confused resident to other residents. ANS: D Medical humor that is used by health care providers to cope is appropriate when kept among staff because it permits sharing of frustration and promotes group cohesion; this type of humor is negative if used with clients (e.g., other residents) and is demeaning and inappropriate. If demeaning humor is used, an assertive response is to remain quiet. It is appropriate for a health care worker to share positive humor (e.g., laugh while watching a television show) with clients. The highest form of positive humor is the ability to laugh at ourselves. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 161, 162 3. A patient who is scheduled for open heart surgery is nervous and tense. The nurse tries to use humor to reduce tension, but the patient seems offended. Which response by the nurse is most appropriate? A. “That joke usually works to relieve tension. Let me try another one to make you laugh.” B. “You need to lighten up a little bit because patients who are anxious have more pain.” C. “I was trying to ease your tension about surgery, and I am sorry for my insensitivity.” D. “Haven’t you ever heard that laughter is the best medicine? Just try to at least smile.” ANS: C If humor is used, and it offends the patient, the nurse should apologize and explain that the intention was to be helpful. If the patient is offended, the nurse should not continue to use humor. The nurse should not tell a patient how to feel or behave (e.g., “you need to lighten up” or “try to at least smile”) or suggest that certain behaviors will increase pain. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 163 4. The nurse prepares to administer the first chemotherapy treatment to a patient. Which statement by the nurse encourages a positive attitude? A. “What brings joy to your life?” B. “Will you be upset if you lose your hair?” C. “What are your concerns about your treatment?” D. “How do you usually cope with stress?” ANS: A The nurse can encourage a positive attitude by asking patients appropriate questions such as: 1) “What brings joy to your life?” 2) “What do you do for fun?” or 3) “What is going well for you today?” Asking a patient about being upset, concerns, or stress does not focus on generating a positive attitude. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 166 MULIPLE RESPONSE 5. Which function(s) of humor in nursing practice has been substantiated by research? Select all that apply. A. Conflicts that occur between nurses and physicians can be managed with humor. B. A patient with a disability may use humor as an effective coping strategy. C. The nurse should not use humor to intervene when a patient is embarrassed. D. A nurse can use humor to establish rapport with a patient who is anxious. E. Positive humor is most appropriate if initiated by the nurse and not the patient. F. Nurses who have a sense of humor are better accepted by patients. ANS: A, B, D, F Evidence supports the use of humor in nursing practice to: 1) cope with conflicts between nurses and physicians; 2) help patients cope with disabilities; 3) establish relationships and rapport; 4) improve the patient’s acceptance of the nurse; and 5) to help nurses intervene when patients are embarrassed. Humor may be inappropriate unless initiated by patients or family members. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 163, 164 Chapter 16: Spirituality Test Bank MULTIPLE CHOICE 1. An elderly patient asks the nurse if faith and regular prayer have any effect on health and longevity. Which response by the nurse is most appropriate? A. “It doesn’t matter what I think, because your beliefs about religion are most important.” B. “You will need to ask a chaplain because I am not allowed to discuss religion.” C. “Health benefits are only associated with individuals who attend church every week.” D. “There is evidence that religious practices are associated with health and living longer.” ANS: D Over 250 studies show that religious practice (e.g., faith and regular prayer) is correlated with greater health and increased longevity. The patient is not asking what the nurse believes about prayer; the patient is asking about evidence relating faith and prayer to health and longevity. It is within the scope of practice for the nurse to address spiritual issues in clinical practice. Findings from over 70 data-based, peer-reviewed published papers show that people who attend religious services on a regular basis have better health outcomes, stronger immune systems, lower stress, and recover from hip fractures and open-heart surgeries more quickly than do less religious people. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 174 2. The nurse provides spiritual care for hospice patients. Which action by the nurse should be completed first? A. Perform spiritual assessments with hospice patients. B. Practice techniques to enrich spirituality and centeredness. C. Determine available resources in the community. D. Practice the art of presence with the patients. ANS: B Nurses must nurture their own spirit before being able to stay connected to the experience of a patient. Practicing techniques (e.g., relaxation techniques, meditation, time in nature, yoga, music) helps nurses to be in touch with their own spirituality and with becoming centered. It is only then that nurses are effective in spiritual assessments, being present, and identifying resources. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 177 3. Which nurse is being fully present with the patient to provide spiritual care? A. The nurse sits quietly with a patient and uses therapeutic touch. B. The nurse gathers a complete health history from a patient. C. The nurse asks if the patient would like the chaplain to visit. D. The nurse reassures a patient while giving medications. ANS: A Spiritual care begins with being fully present; nursing presence is a conscious act of being fully present in body, mind, emotions, and spirit with a patient. Being silent and use of therapeutic touch are examples of being present. Performing tasks or assessments (e.g., obtaining a health history, administering medications) are not examples of being fully present. Spiritual care is more than religion or visitation from a chaplain. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 178 4. The nurse senses the patient has more to say and wants to encourage the patient to continue talking. It is most appropriate for the nurse to state: A. “I think you may not be telling me everything.” B. “How does that make you feel?” C. “Oh …. ?” and wait for the patient to continue. D. “Why do you feel that way?” ANS: C Use encouraging or questioning sounds or body language as cues to encourage the patient to continue talking. Try “Oh ... ?” when you sense that the client has more to say and then be quiet. Avoid the question “How does that make you feel?” which may make patients believe they are being analyzed. Refrain from using “why” because doing so tends to make patients feel threatened. It is better to rephrase the question so it is softer and more receivable. The nurse should not indicate that the patient may be lying or withholding information. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 180 MULTIPLE RESPONSE 5. The nurse is taking a spiritual history from a patient with a terminal illness. Which question(s), if asked by the nurse, would be appropriate? Select all that apply. A. “Would you like me to serve as your spiritual counselor?” B. “What gives your life meaning?” C. “What importance does your faith have for you? D. “Why do you think your spirituality has not saved you?” E. “Are you part of a religious community?” F. “How can I help you address your spiritual needs?” ANS: B, C, E, F The Faith and Belief: Importance, Community, and Address in Care (FICA) tool suggests appropriate questions for taking a spiritual history (see Box 16-1). The nurse may assume the role of spiritual guide to extend love, compassion, and empathy but not to become the patient’s spiritual counselor. It is usually best to refrain from using “why” to ask questions because patients may feel threatened; it is better to rephrase the question so it is softer and more receivable. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: pp. 174, 176 Chapter 17: Requesting Support Test Bank MULTIPLE CHOICE 1. A nurse manager seeks to reduce staff nurses’ stress and promote retention. It is most important for the nurse manager to take which action? A. Develop a mentoring program to provide cognitive and affective support. B. Focus on cognitive support instead of affective or physical support. C. Limit affective support to annual recognition of nurses’ accomplishments. D. Place the highest priority on purchasing equipment to provide for physical support. ANS: A A mentoring program can provide cognitive and affective support; mentor programs have improved retention of nurses. Cognitive, affective, and physical support are equally important to reduce stress and promote retention of nurses. Affective support is acknowledgment for the work nurses do; respect, honor, and recognition should be continually provided and not just during annual reviews or evaluations. Physical support is provided with having the staff, materials, and processes to complete the work; however, staffing is an essential component of physical support and directly linked to retention of nurses. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 191 2. A new graduate nurse feels that the staff nurses are not empathetic and do not provide reassurance or positive feedback. Which action by the graduate nurse is appropriate? A. Use an antagonistic approach to seek support from a nurse who is a mentor. B. Use a nonassertive approach to seek physical support from the staff nurses. C. Use an assertive approach to seek affective support from the nurse manager. D. Use an aggressive approach to seek cognitive support from other graduate nurses. ANS: C Affective support is acknowledgment for the work a nurse does and a feeling of nurturance; the graduate nurse would seek affective support using an assertive approach if a lack of empathy, reassurance, and positive feedback were identified. Cognitive support helps the nurse think intelligently and solve problems. Physical support is the provision of staff, materials, and processes needed to get the work done. Nonassertive, aggressive, or antagonistic approaches are not effective to gain support. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 191 3. A nurse is breastfeeding but has no private, sanitary area to pump breast milk while working; she also discovers that at least 10 other employees at the hospital have the same problem. Which action by the nurse would most likely result in acquiring a clean, private area to pump breast milk? A. The nurse demands that the nursing director provide a private area within one week. B. The nurse develops a clear, detailed plan and suggests several possible private areas. C. The nurse sends an e-mail to the nursing supervisor with a description of the problem. D. The nurse writes a letter to the nurse manager and asks others to add their signatures. ANS: B If the nurse develops a specific and clear plan with sufficient detail, the greater are the chances of obtaining physical support (e.g., a private area). Demanding a space is an aggressive approach that does not give respect to the nursing director. The nurse should make an appointment with the nursing supervisor or manager and not communicate by e-mail or letter. The nurse should not just describe the problem but also offer solutions. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 192 MULTIPLE RESPONSE 4. The nurse manager decides to initiate a mentoring program for new graduate nurses on a medical unit. The nurse manager should consider asking which nurse(s) to serve as mentors? Select all that apply. A. A nurse who excels in nursing knowledge and skills and has a positive attitude. B. A nurse who has excellent communication skills and a positive outlook. C. A nurse who is certified in psychiatric care and works in a mental health setting. D. A nurse who excels as a manager and has an advanced degree in administration. E. A nurse who is warm, empathetic, and has a passion for nursing and helping others. ANS: A, B, E A mentor in nursing represents excellence in knowledge, skill, and competence; affective components are warmth, acceptance, friendliness, empathy, compassion, patience, a willingness to learn and share, and generosity. Mentors have a positive outlook, are loyal and nurturing, enjoy nursing, and have superior communication skills. A nurse with an advanced degree or with certification in a specialty area will not necessarily have the characteristics of a good mentor. DIF: Comprehension TOP: Integrated Process: Caring MSC: Safe and Effective Care Environment: Management of Care REF: p. 200 PRIORITIZING/ORDERING 5. Three emergency department (ED) nurses are interested in initiating a new policy related to family presence during cardiopulmonary resuscitation (CPR). The steps to request support for initiation of this policy are listed below. Arrange the steps in the correct order of use? A. The nurses review literature and survey ED nurses about family presence during CPR. B. The nurses practice their presentation to the nurse manager. C. The nurses identify the need to gain support from the nurse manager for this policy. D. The nurses decide to approach the nurse manager with their idea. E. The nurses develop a specific strategy to present the information to the nurse manager. ANS: C, D, A, E, B The nurses should follow the steps for requesting cognitive support: 1) The first step is to identify their need for support; 2) The next step is to decide if they wish to pursue this support; 3) Once they have decided to try to obtain the support, they must obtain information (e.g., literature review, survey ED nurses); 4) The next step is to design their strategy to present the information; and 5) The nurse should prepare for the presentation to the nurse manager. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 192 Chapter 19: Feedback Test Bank MULTIPLE CHOICE 1. A licensed practical/vocational nurse (LPN/LVN) consistently forgets to administer medications and asks the registered nurse (RN) for specific advice. It is most appropriate for the RN to make which statement? A. “Buy a digital watch with an alarm, and you will never forget again.” B. “Something that helps me is to set the alarm on my watch as a reminder.” C. “You should set the alarm on your watch as a reminder to give medications.” D. “It is best if you set the alarm on your watch when the next medication is due.” ANS: B When giving advice, the RN should offer options as suggestions for the LPN/LVN’s consideration. Suggestions will be more readily received if offered tentatively (e.g., “Something I’ve tried is this.”). If the RN gives advice by telling the LPN/LVN how to change without giving the option to decide, the LPN/LVN’s feelings may be hurt, or the LPN/LVN may not feel respected. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 215 2. The nurse manager of a critical care unit initiates three-hundred-and-sixty degree feedback as a tool to aid in the development of the staff nurses. Who will provide feedback on each nurse’s performance? A. Nurse manager, other staff nurses, and nursing assistants B. Patients, family members, and hospital volunteers C. Physicians, respiratory therapists, and other specialists D. Chief executive officer, nursing director, and nurse manager ANS: A Three-hundred-and-sixty-degree feedback, or multisource performance approval data, is used as a staff development tool because feedback is drawn from peers and subordinates to supplement direct observation by the manager. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 215 3. The nurse cares for a patient who is admitted to the medical unit. The patient has type 2 diabetes mellitus, a blood glucose of 420 mg/dL, and a foot ulcer. Which statement, if made by the nurse, is appropriate when giving feedback to this patient? A. “I am going to tell you what you are doing wrong because I know about diabetes.” B. “You have this foot ulcer because you did not follow your diet and exercise plan.” C. “From my perspective, the foot ulcer occurred because your blood sugars are high.” D. “I know you don’t want to hear this, but uncontrolled diabetes leads to complications.” ANS: C The nurse gives feedback respectfully, if phrases such as “From my perspective ...” are used; the nurse uses the first person to convey thoughts and feelings which prevents accusing or labeling the patient’s behavior. The nurse should not give feedback to display superior knowledge or to rigidly control the behavior of a patient. The nurse should gain permission from the patient to give feedback. The nurse should not give feedback that is general; feedback should focus on specific, observable behavior. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 215, 216 4. A new nurse wants feedback from the other more experienced nurses on the unit. Which request for feedback, if made by the new nurse, would be most appropriate? A. “How do you think I am doing?” B. “I would like to know my strengths and weaknesses.” C. “I still feel incompetent but would like some feedback.” D. “What do you think about the accuracy of my assessments?” ANS: D The new nurse should be specific when requesting feedback by clarifying the aspects of a behavior (i.e., assessment accuracy). The new nurse should avoid vague questions (e.g., “How do you think I am doing?”). The new nurse should not ask for feedback until confident enough to examine the feedback. Receiving feedback with implications for change when unconfident may only serve to make the new nurse feel worse. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 219 PRIORITIZING/ORDERING *5. The nurse is concerned about a nursing assistant who does not immediately report vital signs that are out of normal range. Arrange the nurse’s statements below in the correct order to give assertive feedback to the nursing assistant. A. “I would prefer that you notify me immediately if vital signs are abnormal.” B. “The patients with abnormal vital signs are not evaluated in a timely manner.” C. “When you take vital signs, you do not report abnormal values to me immediately.” D. “I feel uncomfortable because the patients are not receiving safe nursing care.” ANS: C, B, A, D The nurse should give assertive feedback when there is a difficult situation with a nursing assistant. The nurse should follow this formula to give assertive feedback: 1) When you ... (describe the behavior without judging it); 2) The effects are ... (describe concretely how it affects the individual’s life in a practical sense); 3) I feel ... (describe feelings without blaming; the “I” statement implies ownership of feelings); and 4) I prefer ... (describe what response or change is desired, or, if possible, give the other person a chance to come up with a solution). ➢ Prefer  Feel DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 217 Chapter 20: Relaxation Test Bank MULTIPLE CHOICE 1. The nurse supervises a nursing assistant who reports feeling stress and not being able to relax. When talking with the nursing assistant, which statement by the nurse is best? A. “I suggest meditation, but meditation works better if you eat a healthy diet.” B. “Relaxation strategies do not work until you learn to control negative emotions.” C. “All you need to do to relieve stress is take short breaks and get eight hours of sleep.” D. “You will be more relaxed if you stop wasting time being with close friends.” ANS: A Relaxation strategies (e.g., meditation) work best when a person is not totally depleted. To make the best use of relaxation skills, self-care needs should be met. Self-care should include eating nutritious foods, taking breaks while at work, dealing with emotions (e.g., with fear, frustration, hurt) that lead to anger, nurturing relationships with others, and getting eight hours of sleep. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 222 2. Which activity, if performed by the nurse, can improve patient safety? A. Pass up breaks to provide more time for patient care. B. Consume processed foods to increase energy level. C. Practice progressive relaxation exercises every day. D. Remain alert by not practicing meditation before work. ANS: C Daily relaxation techniques (e.g., progressive relaxation, meditation) eliminate the negative build-up of stress and help nurses become more focused and alert, promoting safety for clients and for themselves. Stress is a result of unhealthy habits (e.g., eating processed foods, not taking breaks). DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 223 3. A supervisor instructs a nurse on how to use meditation to relax and to reduce stress. Which statement, if made by the nurse, indicates teaching is successful? A. “I can use meditation to reduce tension if stressful situations occur on the unit.” B. “If distracting thoughts occur while meditating, I will focus on these thoughts.” C. “I should practice meditation for at least 15 minutes every day.” D. “Meditation is most effective for people with strong religious beliefs.” ANS: C To experience benefits from meditation, it is desirable to meditate for 15 to 20 minutes at least once a day. This commitment means setting aside that time consistently. Although meditation is rooted in spiritual traditions, the practice of meditation does not require belief in any particular religious or cultural system. Distracting thoughts are likely to occur during meditation, especially at first; the nurse should let these thoughts pass without becoming worried. Meditation can help the nurse learn to maintain a calm perspective, but meditation is not practical while on the unit. DIF: Application TOP: Integrated Process: Teaching/Learning MSC: Psychosocial Integrity REF: pp. 224, 225, 227 4. The nurse teaches a client about relaxation techniques that can be used to reduce situational stress. Which statement by the client requires an intervention from the nurse? A. “Relaxation techniques can give me self-confidence and a feeling of competence.” B. “If an angry person is going to talk to me, I can imagine myself getting a massage.” C. “I should use abdominal breathing to help me relax in stressful situations.” D. “Progressive stretching exercises are more effective than meditation to relieve stress.” ANS: D Muscle stretches augment the benefits of meditation and on-the-spot exercises; relaxation strategies are equally effective in reducing stress. Relaxation techniques can change feelings of tightness and fear to relaxation and a feeling of competence and create inner self-confidence. Imagery (e.g., of massage) can help a person cope with an unexpected stressful interpersonal encounter. Abdominal breathing is an on-the-spot method for relaxing the body. DIF: Application TOP: Integrated Process: Teaching/Learning MSC: Psychosocial Integrity REF: pp. 228-230 MULTIPLE RESPONSE 5. Which are known causes of workplace stress for nurses? Select all that apply. A. Increased acuity of patients B. Shortage of personnel C. Increase in available resources D. Reduced workload E. Distressing patient situations F. Communicating with colleagues ANS: A, B, E, F Causes of stress in nursing include the following: 1) Increased acuteness of clients’ conditions; 2) shortage of personnel; 3) distressing and anxiety-provoking situations; 4) changing exposure to different personnel in a complex working environment; 5) insufficient resources; and 6) excessive workload DIF: Comprehension TOP: Safe and Effective Care Environment: Management of Care MSC: Psychosocial Integrity REF: p. 223 Chapter 21: Imagery Test Bank MULTIPLE CHOICE 1. A nurse attends an education session on effective communication. Which statement, if made by the nurse, indicates an understanding of how imagery may be used to build confidence when communicating with patients and colleagues? A. “Imagery is most successful if visualizations are ambiguous and constrained.” B. “Imagery will only be effective if individuals are actively involved in the visualizations.” C. “Imagery works because the brain does not discriminate between thoughts and actions.” D. “Imagery is a process of using pictures to remember past events with positive regard.” ANS: C Research supports the idea that imagery works because the brain does not distinguish between an image and the experience of the imagined place or situation. Imagery is most successful if the visualization is clear and the course of action is committed; there should be neither limitations nor constraints. Not everyone images the same way. Some individuals are actively involved in the image, while others see it as actors on a stage or get only sensory impressions without a clear image. Imagery or visualization is a process of mentally picturing an event we wish to occur in the present or future. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 233, 234 2. Which change indicates to the nurse that a patient is responding favorably to using imagery? A. The patient’s blood pressure is better controlled. B. The patient develops maladaptive coping strategies. C. The patient’s healing time is increased. D. The patient’s immune response is suppressed. ANS: A Imagery is an effective intervention to control blood pressure, to promote coping, to optimize healing, and to improve the immune response. DIF: Comprehension TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity REF: pp. 235, 236 3. The nurse plans to use imagery as an alternative language when removing a urinary catheter. Which statement, if made by the nurse, would be most appropriate? A. “Removing a catheter really hurts.” B. “You will not feel anything.” C. “It will be briefly painful.” D. “You may feel a burning sensation.” ANS: D The nurse can use imagery when performing procedures. Imagery as an alternative language is truthful but suggests a different sensation than anticipated. When removing a urinary catheter, the nurse would describe the sensation as “burning” instead of as “painful” or “really hurts.” This language decreases anxiety and shifts the pattern from response to “pain” to response to “burning.” The nurse should convey sensations that are truthful; the nurse should avoid statements such as “You will not feel anything.” DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 236 4. The nurse instructs a colleague about how imagery can build confidence when communicating with other health care providers. The nurse determines further teaching is necessary if the colleague makes which statement? A. “Visualizations are most effective if the focus is on preparation for the encounter.” B. “Before visualization I will clearly determine the desired outcome.” C. “It is important to take three or four deep breaths before using imagery.” D. “If I practice imagery regularly, the technique will be more effective.” ANS: A To be more prepared, the colleague should visualize the entire interaction which includes prior to the interaction (or preparation time), the interaction (or direct encounter), and postinteraction. By mentally going through the whole encounter, you will be much better prepared. The individual must be clear about what will be communicated and determine the desired outcome. Imagery is most effective when the person is relaxed, so the person should begin imagery with three deep breaths to facilitate relaxation. It is important to practice imagery because the person will be able to go through the steps quickly and effectively. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 238 MULTIPLE RESPONSE 5. Which imagery techniques would improve a nurse’s communication skills? Select all that apply. A. Self-confidence will be improved if the nurse critically reviews communication errors. B. If the interaction will be stressful, the visualization should be practiced several times. C. Actual words and actions should be included in visualizations rather than feelings. D. The nurse should evaluate the effect of imagery on self-confidence after the interaction. E. Visualize coping with unexpected events that may occur during the interaction. ANS: B, D, E For those interpersonal situations in which the nurse feels uncomfortable, it is wise to repeat a positive visualization several times. After an interaction, the nurse should take time to evaluate how the session went. To augment confidence, it is wise to envision unexpected events that may be encountered and practice how to cope with them. Self-evaluation should focus on how imagery positively affected the interaction. The nurse should not focus on errors; but, rather how imagery could be used for continued improvement in communication skills. DIF: Comprehension TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 239, 240 Chapter 22: Positive Self-Talk Test Bank MULTIPLE CHOICE 1. A nurse constantly tells a nursing student that she is not able to complete her patient assessments accurately. Which statement, if made by the nursing student to herself, indicates that her internal dialogue is negative? A. “Normal assessments are easy; I can learn the abnormal.” B. “I am dim-witted when it comes to making assessments.” C. “That nurse obviously does not know me very well.” D. “I can make it as a nurse; I just need more practice.” ANS: B Internal dialogue (or self-talk) is a continuous and powerful influence on a person’s well-being and performance. Internal dialogue can be destructive and cause problems when it is irrational, unrealistic, or ineffective. The nursing student who tells herself that she is dim-witted may never be able to develop accurate assessment skills. Other statements by the nursing student demonstrate positive self-talk which is constructive and will most likely lead to improved and accurate patient assessments. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 245 2. Which situation may be difficult for the nurse to communicate assertively and responsibly if self-talk is negative? A. A colleague provides constructive criticism on how the nurse gives report. B. An interdisciplinary team compromises on a patient care issue. C. A patient is angry because pain has not been adequately controlled. D. A supervisor gives the nurse a superior rating on an annual review. ANS: C Positive self-talk is important in situations that are known to be difficult for nurses to communicate assertively and responsibly. These situations include: 1) When clients or colleagues are distressed; 2) When clients or colleagues are aggressive; 3) When there is team conflict; 4) When evaluation anxiety is experienced; and 5) When unpopular clients are encountered. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 249 3. The nurse suggests that patients use affirmations to develop a sense of well-being and health. Which affirmation would be appropriate for the nurse to recommend to this patient? A. I am too sensitive about my weight. B. I must exercise every day. C. I will not eat processed foods. D. I feel great today. ANS: D Affirmations are positive self-talk statements. “I feel great today” is in the present tense, optimistic, short, and specific. The other statements are negative, destructive, and pessimistic. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 251, 252 4. A nurse wants to remain hopeful and optimistic when working with hospice patients. Which would be appropriate affirmations for the nurse to use? A. Write down short, specific positive statements. B. Review written, positive statements two to three times per month. C. Develop a new positive statement every two to three days. D. Use statements that refer to positive actions that will occur in the future. ANS: A Affirmations are positive self-talk statements of what the nurse wants, written in the present tense, as if they have already happened. Affirmations can help the nurse take an optimistic point of view about life and work. Statements should be written, short, and very specific. The nurse should believe that the affirmation is happening. In addition, the affirmations should be repetitive and be reviewed at a specific time on a daily basis. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 251, 252 PRIORITIZING/ORDERING 5. The nurse wants to communicate in a responsible and assertive manner by using positive self-talk. The steps to change self-talk from negative to positive appear below. Arrange the steps in the correct order of use. A. Learn how to stop negative self-talk. B. Assess whether self-talk is positive or negative. C. Change internal dialogue to positive self-talk. D. Perform positive self-talk without effort. E. Develop an awareness of self-talk. ANS: E, B, A, C, D The following steps should be used to change negative self-talk to positive self-talk: 1) The nurse should develop an awareness of self-talk; 2) The nurse should determine if self-talk is positive or negative; 3) The nurse should learn how to stop negative self- talk; 4) The nurse should change internal dialogue to positive self-talk; and 5) The nurse should be able to perform positive self- talk without effort. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 247 Chapter 06: The Changing World of Electronic Communication Test Bank MULTIPLE CHOICE 1. The patient asks the nurse to explain why computers are needed in health care. Which response by the nurse is best? A. “Electronic communication by computer is rarely misunderstood.” B. “Computers eliminate problems with protecting patient information.” C. “The computer is used to promote safe and effective patient care.” D. “Use of technology such as computers assures safe, quality patient care.” ANS: C Electronic communication is used in health care to promote patient safety and effective quality care. Electronic communication does not guarantee safe, quality patient care. Electronic communication can be easily misunderstood because nonverbal cues are not available. Breach of confidentiality can occur with electronic communication. DIF: Analysis TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 71 2. The nurse is updating a patient care policy based on current literature. Which action by the nurse is best? A. Search online for similar policies from other hospitals. B. Review the table of contents of several current journals. C. Ask the librarian at the public library for assistance. D. Use Google Scholar to locate appropriate journal articles. ANS: D An effective and efficient way to locate current literature is by electronic searches; Google Scholar is appropriate for the nurse to locate scholarly journal articles. Similar policies from other hospitals are not equivalent to a review of current literature. Review of a journal’s table of contents is not an efficient method to locate current literature. Consultation with a librarian is appropriate; the librarian will suggest electronic searches such as Google Scholar, CINAHL, or PubMed. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 73 3. The nurse manager plans to send an e-mail to staff nurses about a new policy. It is most important for the nurse manager to take which action? A. Request a receipt of the message. B. Type the message in uppercase letters. C. Use SMS language to write the message. D. Leave the subject line of the message blank. ANS: A The nurse manager may request a receipt from the staff nurses when the e-mail has been opened and read. Messages should not be typed in uppercase letters, because this may be perceived as shouting. SMS language is used with text messages and is shortened versions of normal words with abbreviations and representations of particular words with certain patterns. The subject line should be used to identify the content of the e-mail. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 71, 72 4. The nurse is preparing an electronic professional portfolio to provide to potential employers. The nurse determines that which is appropriate to include in the portfolio? A. A video recording on YouTube of the nurse performing a procedure on a client. B. A sample of actual charting from clients’ electronic medical records. C. Access to a social networking site established by the nurse for a client support group. D. Electronic resume with scanned copies of awards, certificates, and diplomas. ANS: D A Web-based service is available for the nurse to create an electronic portfolio, holding word processing-type data and scanned copies of your college diplomas, awards, certificates, professional presentations, etc. The nurse can give access to the electronic portfolio to potential employers. Client information (e.g., video of procedure, electronic medical record charting, and social networking support group) is confidential and sharing confidential information is a Health Insurance Portability and Accountability Act (HIPPA) violation. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 75 5. The nurse evaluates a Web site for patients with hypertension. Which, if included on the Web site, would the nurse question? A. The Web site was written by a nurse practitioner. B. The last update to the Web site was 5 years ago. C. References are from peer-reviewed journals. D. The language is at the fifth-grade reading level. ANS: B Health information on Web pages should be updated regularly; information on hypertension should be updated yearly or more often. A nurse practitioner has the credentials appropriate to write and review patient information on hypertension. Peer reviewed journals are appropriate sources for information on hypertension. Patient information should be written between a fourth- and sixth-grade reading level. DIF: Analysis TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 78 6. A nursing assistant cannot remember the password for the hospital computer to chart vital signs and personal care given to patients. Which response by the nurse supervising the nursing assistant is most appropriate? A. “I will give you my password so you can chart before you leave.” B. “Look up your password, and chart the information tomorrow.” C. “If you write down the information, I will chart for you.” D. “You will need to obtain your password from the computer specialist.” ANS: D If a health care provider is not able to remember his or her password to access electronic health care records, the individual should contact the designated person to obtain a new password. Health care providers should not share passwords or document under another individual’s password. Health care providers should never document for another person. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 78 7. The hospital nurse managers are planning for the implementation of electronic medical records for documentation by the staff nurses. The nurse managers should take which action first? A. Initiate electronic bar-code medication administration. B. Teach the nurses to use a digital camera to supplement charting. C. Determine the computer skills of the staff nurses. D. Alter nursing workflow to accommodate timely charting. ANS: C Evaluation of basic computer skills of the staff nurses is a priority before starting electronic medical record (EMR) training. Electronic bar-code medication administration can be implemented either before or after EMRs. Digital pictures can provide visible evidence to support documentation, but it is more important to assess the nurses’ computer skills. Timely charting is important with EMR because other health care providers are able to access patient information; this information must be up to date because decisions are made based on this data. EMRs should be designed around the nurse’s workflow. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 77 8. The nurse instructs a patient with a chronic disease about locating health information on the Internet. Which Web site would the nurse recommend as a reliable source of information from a private source? A. National Institutes of Health (http://health.nih.gov/) B. Centers for Disease Control and Prevention (http://www.cdc.gov/) C. National Institute on Aging (http://www.nia.nih.gov/) D. American Heart Association (http://www.americanheart.org/) ANS: D The American Heart Association Web site is a private source of reliable health information for patients. The National Institutes of Health, the Centers for Disease Control and Prevention, and the National Institute on Aging are government Web sites. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 81 9. The home health nurse uses a smartphone to access drug information while visiting patients. The nurse is using which form of electronic communication? A. Health Care Apps B. Google Scholar C. PubMed D. Electronic Health Record ANS: A Health Care Apps is a cyberspace-based software (or application) accessed through a network device such as a smartphone. Apps provide clinicians with almost unlimited references at their hands instantly. Google Scholar is a search engine used by health care providers to locate journal articles. PubMed is used by health care providers to search for interdisciplinary professional journals from all types of medicine, nursing, pharmacology, etc. The electronic health record system (EHRs) is usually a software application loaded into multiple computers through a hospital's intranet system. DIF: Comprehension TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 76 MULTIPLE RESPONSE 10. A nurse is employed at a hospital as a nurse informatician. Which skill(s) are necessary for this professional role? Select all that apply. A. Clinical expertise in nursing B. Experience with social media C. Understanding of information technology D. Computer knowledge and experience E. Electronic medical record software development ANS: A, C, D The nurse informatician must be able to integrate nursing science, computer science, and information science. In addition, the nurse should have education and experience in both clinical nursing and information technology. Software development and social media experience are non-essential skills for the nurse informatician. DIF: Comprehension TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 71 Chapter 18: Overcoming Evaluation Anxiety Test Bank MULTIPLE CHOICE 1. The nurse is anxious before meeting with the nurse manager for an annual performance evaluation. Which physical symptom would the nurse expect? A. Hypoventilation B. Increased concentration C. Decreased heart rate D. Palpitations ANS: D Physical symptoms that occur with evaluation anxiety include palpitations, increased heart rate, hyperventilation, and difficulty concentrating. DIF: Comprehension TOP: Nursing Process: Assessment MSC: Psychosocial Integrity REF: p. 204 2. The nurse evaluates care provided by a licensed practical/vocational nurse (LPN/LVN). The nurse determines that the LPN/LVN has high evaluation anxiety if which is observed? A. The LPN/LVN compares self-performance to how other nurses are performing. B. The LPN/LVN is not concerned about how the nurse is evaluating performance. C. The LPN/LVN focuses on the actual tasks rather than thinking about self-performance. D. The LPN/LVN blames external factors if performance is inadequate or poor. ANS: A The nurse with high evaluation anxiety tends to place high emphasis on how he or she is doing in comparison to others. Nurses with low evaluation anxiety will not be concerned about how the examiner is evaluating their performance, will be focused on the task and not their performance, and will blame external factors if performance is poor. DIF: Comprehension TOP: Nursing Process: Evaluation MSC: Safe and Effective Care Environment: Management of Care REF: p. 204 3. A nurse who is extremely anxious about an upcoming evaluation with the nurse manager asks a mentor who is an experienced nurse for advice. Which approach should the mentor recommend to control evaluation anxiety? A. Avoid making medication errors and always provide safe nursing care. B. Practice positive self-talk daily and during the evaluation. C. Articulate your goals before the nurse manager gives feedback. D. Agree to the suggestions given by the nurse manager on how to improve. ANS: B Positive self-talk is an approach that can help the nurse to overcome evaluation anxiety; this approach will replace self-defeating internal dialogue with a reassuring inner voice that is comforting. It is unrealistic to set a goal to avoid all errors and always provide safe nursing care; this standard requires perfection and may actually increase tension and anxiety. The nurse manager should be given uninterrupted time to provide comments before the nurse shares professional goals. If the nurse manager has suggestions about ways in which the nurse can improve performance, the nurse should only agree to those changes that are realistic and supported by the workplace. DIF: Application TOP: Nursing Process: Evaluation MSC: Safe and Effective Care Environment: Management of Care REF: p. 206, 207 4. The nurse receives criticism during a performance evaluation by a nursing supervisor. Which response by the nurse is most appropriate? A. Disregard criticism that is given on more than one evaluation. B. Reply with incivility if the criticism is destructive or disrespectful. C. Ask for specific details or examples of the behavior being criticized. D. Avoid confrontation if the evaluator gives unfair criticism. ANS: C The nurse should seek more information from the person who is giving the criticism by asking for specific facts about the particular behavior; this information helps to determine the validity of the criticism. The nurse should be assertive and reply to unjust or aggressive criticism; the nurse should not let it pass without speaking up. Reply to criticism with civility; incivility, rude or discourteous behavior violates the desired climate of mutual respect. If the nurse receives criticism more than once, the nurse should take note of it; there is likely some truth to criticism heard repeatedly. DIF: Application TOP: Nursing Process: Evaluation MSC: Safe and Effective Care Environment: Management of Care REF: p. 209, 210 MULTIPLE RESPONSE 5. Choose the examples of the major factors underlying evaluation anxiety experienced by nurses. Select all that apply. A. Administering a medication incorrectly that results in a patient death. B. Difficulty using therapeutic communication techniques with patients. C. Losing a job because nursing care does not meet safety standards. D. Inability to accept constructive criticism from a supervisor. E. Fear of being accused of drug diversion. ANS: A, C The two major factors underlying a nurse’s evaluation anxiety are concern for client safety (e.g. unsafe nursing practice) and concern for personal security (e.g., loss of job, loss of income). DIF: Application TOP: Nursing Process: Evaluation MSC: Safe and Effective Care Environment: Safety and Infection Control REF: p. 204 Chapter 23: Confrontation Test Bank MULTIPLE CHOICE 1. A male patient with hypertension tells the nurse that he follows the reduced sodium diet and takes the antihypertensive medication as prescribed. The patient has had no reduction in blood pressure. The nurse plans to confront the patient regarding this discrepancy. Which indicates to the nurse that confronting the patient is effective? A. The patient tells the nurse that it was not his fault that the prescribed treatment failed. B. The patient cooperates with prescribed treatment and an actual behavior change occurs. C. The patient shares feelings about his diagnosis and refuses to make any changes. D. The nurse provides information for the patient to make an informed decision. ANS: B Confrontation provides feedback regarding discrepancies in the patient’s behavior in such a manner that the desired behavior change occurs. Confrontation holds the patient accountable for solving health problems. Feelings are not the focus of confrontation with the patient. Autonomy is the focus of giving the patient information needed to make a decision. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 256, 257 2. The charge nurse observes a staff nurse delegate inappropriate tasks to a nursing assistant. Which action by the charge nurse is most appropriate? A. Avoid talking about the situation with the staff nurse. B. Continue to observe the staff nurse’s behavior for 3 months. C. Respectfully request that the staff nurse use appropriate delegation. D. Post delegation guidelines in the report room. ANS: C The charge nurse should confront the staff nurse in a caring way by respectfully requesting a behavior change. Confrontation is assertive; silence (e.g., avoidance, continuing to observe, posting guidelines) involves nonassertive actions. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 257 3. The nurse plans to confront a visitor who brings candy to a patient with diabetes. Which statement, if made by the nurse, would be most appropriate? A. “It is acceptable to bring candy, but you must give it to the nursing staff.” B. “Why can’t you bring vegetables instead of candy for the patient?” C. “You should not bring candy because the patient has diabetes.” D. “The patient needs a healthy snack, and you can help by bringing fresh fruit.” ANS: D Assertive confrontation has two parts: 1) Making others aware of the destructiveness or lack of productiveness of their behavior; and 2) Making a suggestion about how visitors could behave in a more constructive or productive way. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 257 PRIORITIZING/ORDERING 4. A client uses offensive language when communicating with the nurse. The nurse plans to confront the client in a caring, respectful manner. Arrange the elements of confrontation in the correct order of use. A. Ask the client to avoid using offensive language. B. Tell the client that offensive language is a problem. C. Explain positive consequences of using appropriate language. D. Describe how the offensive language is disrespectful of others. ANS: B, D, A, C The CARE (Clarify, Articulate, Request, Encourage) Confrontation elements are: 1) Clarify the behavior that is problematic; 2) Articulate why the behavior is a problem; 3) Request a change in the client’s behavior; and 4) Encourage the client to change by emphasizing the positive consequences of changing or the negative implications of failing to change. DIF: Comprehension TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 257 MULTIPLE RESPONSE 5. Which situation(s) would be appropriate for the nurse’s use of confrontation? Select all that apply. A. Another nurse consistently withholds pain medication from Hispanic patients. B. A parent continues to smoke in the presence of a child who is diagnosed with asthma. C. A patient asks several questions about newly prescribed medications. D. A pregnant woman drinks 2 to 4 alcoholic beverages each day. E. A staff nurse is selected by a nursing supervisor to attend a conference. ANS: A, B, D It is appropriate for the nurse to confront clients or colleagues in two situations: 1) When clients’ or colleagues’ behaviors are unproductive or destructive to them; or 2) When clients’ or colleagues’ behaviors invade the nurse’s rights or the rights of others. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 257 Balzer Riley: Communication in Nursing, 7th Edition Chapter 24: Refusing Unreasonable Requests Test Bank MULTIPLE CHOICE 1. A nurse cares for four patients on a medical unit. Which request, if made by another nurse, is unreasonable? A. “Will you give a pain medication to one of my patients if needed while I am on a break?” B. “I need another nurse to verify this drug calculation. Will you make sure this is correct?” C. “Can I leave a couple hours early today? I need to apply for a loan at the bank.” D. “My patient is confused. Can you check the patient when you walk by the room?” ANS: C A request may be unreasonable if it affects the nurse’s right to provide safe nursing care (e.g., caring for additional patients while a nurse leaves early for personal reasons). Reasonable requests (e.g., administering pain medications, performing drug calculations, observing confused patients) are respectful and safe. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 265 2. A nurse manager asks an intensive care unit nurse to work an additional 8 hours after a 12-hour night shift. Which statement, if made by the nurse, would be most appropriate? A. “I considered your request; it is not safe for me to work extra hours.” B. “I was really busy last night, but I will stay for another 8 hours.” C. “I will be more alert after drinking a few cups of coffee this morning.” D. “I do not want to work extra, but I do not really have a choice.” ANS: A The nurse should check resources (e.g., time, energy) before agreeing to any request. If the request is unreasonable, the nurse should refuse. It is better to refuse than to risk patient safety. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 266 3. A staff nurse is asked by the nursing supervisor to be a preceptor for a new graduate nurse. The staff nurse is an excellent role model but wants to go back to school for an advanced practice degree. Which response by the staff nurse is most appropriate? A. “I will be a preceptor even if I need to postpone taking classes for my advanced degree.” B. “If you cannot find another nurse to be a preceptor, I will volunteer for the job.” C. “I am honored by this request, however, I have made it a priority to go back to school.” D. “I enrolled in classes for an advanced degree, but I will still have time to be a preceptor.” ANS: C Assertive communication is based on a consideration of both party’s needs and recognizes that each person has the right to set priorities for actions and time allocation. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 266 4. A nurse educator teaches a staff nurse how to say no effectively. Which statement, if made by the staff nurse, indicates an understanding of the instructions? A. “My rights will be protected, if I project my voice and give several excuses.” B. “I should state my reason for saying no and suggest a possible solution.” C. “It is important to provide a detailed excuse that is logical.” D. “If I seem hesitant and avoid eye contact, saying no is believable.” ANS: B The staff nurse can say no effectively by indicating the reason for saying no and suggesting an alternative source of help if appropriate. The staff nurse should not begin a refusal with a list of lengthy excuses. Also, the staff nurse should not be hesitant, lose eye contact, or use a raised voice. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 267, 270 MULTIPLE RESPONSE 5. Which are potential negative consequences that may occur when a nurse refuses a request? A. Embarrassment B. Respect C. Defensiveness D. Helplessness and guilt E. Vision ANS: A, C, D Nonassertive or aggressive behavior when responding to a request may make the staff nurse feel guilty, helpless, embarrassed, or defensive. An assertive response to an unreasonable request is the way to show respect and to invest in personal visions and goals. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 267 Chapter 25: Communicating Assertively and Responsibly with Distressed Clients and Colleagues Test Bank MULTIPLE CHOICE 1. The nurse plans to teach colleagues about how to deal with distressed clients. Which statement by a colleague indicates to the nurse that further instruction is needed? A. “Loss of control is a common cause of stress for clients.” B. “My reaction to a client who is distressed is important.” C. “If my response is therapeutic, distress will be relieved.” D. “Interactions with distressed clients are opportunities to learn.” ANS: C Use of therapeutic communication does not guarantee that clients will be less distressed. When communicating with distressed clients, the nurse should use this as an opportunity to learn and build new skills that increase communication effectiveness. Common issues that can cause distress are loss of control, change, sense of threat, and unrealized expectations . The stressful situation itself does not cause problems. What is most important is the nurse’s reaction to the stressful situation. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 274 2. A nurse has returned to work after maternity leave and is upset about being assigned to float to another unit. The nurse yells at the charge nurse and says that she is exhausted from lack of sleep and is anxious about leaving her baby in day care. Which assessment of the situation, if made by the charge nurse, is most appropriate? A. The nurse is experiencing distress about returning to work. B. The nurse wants other colleagues to feel sorry for her. C. The nurse does not like to float to other units. D. The nurse is not able to take direction from others. ANS: A When communicating with an upset colleague, it is important to accurately assess the situation and determine the colleague’s thoughts and feelings and requests. The nurse is anxious about separation from her baby; the nurse is making a request to not have additional stress today by floating to another unit. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 276 3. The nurse cares for a patient who has been diagnosed with a terminal illness. The patient is crying and refuses to eat snacks or meals. Which statement, if made by the nurse, is best? A. “Most patients feel better if they eat something.” B. “I am sorry you are upset about your diagnosis.” C. “You seem sad; I will stay with you for a while.” D. “Let me order something special for you to eat today.” ANS: C The patient is feeling sad and may need to verbalize feelings; the nurse should provide understanding and comfort. The nurse should acknowledge the patient’s feelings and encourage the patient to verbalize feelings by offering self. The other statements are nontherapeutic communication strategies (e.g., generalization [“Most patients …], apology [I am sorry …], avoidance [“Let me order …]). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 280 PRIORITIZING/ORDERING 4. A family member is upset about restricted visiting hours for a patient who is critically ill. The nurse plans to speak with the family member. The steps for communicating successfully with a distressed person appear below. Arrange the steps in the correct order of use. A. Determine an appropriate communication behavior. B. Communicate in an assertive and responsible manner. C. Appraise the family member’s thoughts, feelings, and requests. D. Decide on the desired outcome. E. Review the encounter for effectiveness. ANS: C, A, D, B, E When dealing with distressed individuals the nurse should complete the following steps: 1) Formulate an assessment of the individual’s thoughts, feelings, and requests; 2) Determine an appropriate communication strategy; 3) Identify the desired outcome of the communication strategy; 4) Implement the planned communication strategy; and 5) Evaluate the communication strategy. DIF: Comprehension TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 275, 276 MULTIPLE RESPONSE 5. A nurse cares for patients in a burn unit. Which statement, if made by the nurse, indicates that shadow grief may be occurring? Select all that apply. A. “I care about my patients and want to be a good nurse.” B. “I just do not have any get-up-and-go at work anymore.” C. “I use my presence to help patients who are distraught.” D. “I feel so apathetic most days and do not want to do anything fun.” E. “My family gets upset with me because I discuss work too much.” ANS: B, D, E Shadow grief occurs when the nurse picks up the sadness of patients. Nurses experiencing shadow grief have less energy, experience no zest for living, and talk about their patients continuously, even during off hours. Nurses need to develop ways to relate to distressed patients without upsetting themselves. Maintaining sensitivity to patients is important so that nurses can respond in caring ways without being overcome and losing objectivity. Nurses must exhibit presence without giving themselves away. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: pp. 273, 274 Chapter 26: Communicating Assertively and Responsibly with Aggressive Clients and Colleagues Test Bank MULTIPLE CHOICE 1. A student nurse is not able to start an IV after two attempts. Two staff nurses laugh and call the student nurse “stupid.” The student nurse reports the staff nurses’ behavior to the charge nurse. Which response by the charge nurse is best? A. “This is an example of verbal abuse and is inappropriate.” B. “I think the nurses were just joking to relieve stress.” C. “The staff nurses did not mean to hurt your feelings.” D. “You just need more practice starting IVs.” ANS: A Verbal abuse (e.g., name calling, labeling) is communication via behaviors that patronize, demean, isolate, disparage, threaten or accuse, or intend that the individual feel attacked or humiliated. Student nurses and new graduates are often the most vulnerable. Verbal abuse is not an appropriate use of humor. Verbal abuse in the workplace is aggressive and a learned behavior; it should not be accepted as “just the way things are.” Aggressiveness may also indicate another person’s lack of respect for our feelings or a violation of the right to be treated with courtesy and consideration. The charge nurse should not focus on the student nurse’s skill for starting an IV but rather deal with the report of verbal abuse. DIF: Application TOP: Integrated Process: Caring MSC: Safe and Effective Care Environment: Management of Care REF: p. 288 2. The nurse manager teaches a group of graduate nurses how to respond to angry colleagues effectively. Which statement, if made by a graduate nurse indicates a need for further instruction? A. “It is important to consider your colleague’s point of view.” B. “Anger may be caused by frustration or fear of loss of control.” C. “I should avoid interactions with angry colleagues.” D. “I may feel uncomfortable when dealing with an angry colleague.” ANS: C Nurses should be assertive and confront a colleague who is angry instead of using avoidance. When dealing with angry expressions, it is important to consider the other person’s point of view. Anger is based on a sense of powerlessness, frustration, and fear of loss of control. It is common to feel discomfort when a colleague expresses anger. DIF: Application TOP: Integrated Process: Caring MSC: Safe and Effective Care Environment: Management of Care REF: p. 289 3. A family member of a critically ill patient is irritated and upset. Which statement, if made by the nurse, would be most appropriate? A. “Why are you feeling upset?” B. “You should not feel so upset.” C. “What have I done to make you upset?’ D. “Tell me what is upsetting you today.” ANS: D The nurse should attempt to determine the reason the family member is irritated and upset. An open-ended statement (e.g., “Tell me …”) is an assertive, respectful, nonthreatening, and empathetic way to request more information. The nurse should avoid threatening questions (e.g., “Why are you …”), telling others how to feel (e.g., “You should not feel …”), and leading questions (e.g., “What have I …”). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 289 4. The nurse educator instructs staff nurses about how to respond effectively to colleagues who exhibit abusive behaviors. Which would indicate that teaching was effective if performed by a staff nurse? A. A staff nurse remains calm and controlled when a colleague is abusive. B. A staff nurse explains to an abusive colleague how the comments increase self-esteem. C. A staff nurse shares feelings with a colleague who is consistently aggressive. D. A staff nurse responds to an abusive colleague with aggression. ANS: A Remaining calm and controlled with an aggressive colleague provides a contrast that may help the colleague realize that the behavior is inappropriate. Pointing out the effect of the abusive behavior (e.g., abusive comments decrease self-esteem) is a technique to heighten the awareness of an aggressive colleague. When a colleague is repeatedly aggressive, using “I feel …” may be ineffective; the nurse should comment on the results of the behavior and then make a request for a behavior change. Ignoring or dismissing aggression may decrease a colleague’s abusive behavior. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 289 MULTIPLE RESPONSE 5. The nurse cares for a patient who is angry about not being able to smoke while in the hospital. Which measures should the nurse implement when formulating a response to this patient? Select all that apply. A. Remain calm and take a few deep breaths before speaking. B. Choose words that convey respect for the patient. C. Take the angry behavior personally to avoid misunderstandings. D. Stay a distance of three to six feet away from the patient. E. Respond with aggression to provide a safe environment. ANS: A, B, D When dealing with an angry patient, the nurse should 1) breathe deeply and remain calm: 2) maintain personal space from the patient; 3) choose words carefully to demonstrate respect for the patient; 4) avoid taking the angry behavior personally; and 5) assertive communication is effective for dealing with conflict. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 289 Chapter 27: Communicating Assertively and Responsibly with Unpopular Clients MULTIPLE CHOICE 1. A patient with a rare disease continually complains to the nurse about receiving inadequate nursing care. Which is a common reaction by a nurse to this type of patient behavior? A. The nurse shows respect and concern for the patient. B. The nurse develops feelings of frustration and incompetence. C. The nurse will spend more time with the patient. D. The nurse develops improved job satisfaction. ANS: B Nurses commonly react with feelings of frustration and incompetence when caring for unpopular patients who complain or are a complicated case. Other common reactions to unpopular patients include job dissatisfaction, ignoring or avoiding the patient, and acting cool, detached, or insensitive. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: pp. 308, 309 2. Which client would most likely receive courteous care that meets quality standards for nursing practice? A. A client who is wealthy and expects to be treated better than others. B. A client who tells tasteless jokes about nurses and laughs at the nurses. C. A client who follows the recommended diet and takes prescribed medications as directed. D. A client who reports pain and requests medications that are not prescribed. ANS: C Popular clients may receive more courteous nursing care and a higher quality of care than unpopular clients. Popular clients have the following characteristics: 1) able to joke and laugh with the nurses; 2) determined to get well again; 3) cooperative and compliant with the therapeutic regimen; 4) managed by routine methods; 5) rarely complain of pain or discomfort; and 6) minimize the trouble they cause staff by being cooperative. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 309 3. The nurse observes a student nurse exhibiting negative feelings toward patients who are incontinent. Which statement if made by the nurse is most appropriate? A. “Changing your attitude will automatically change how you act.” B. “It would be better if you did not take care of incontinent patients.” C. “You need to change how you feel about incontinent patients.” D. “How would you feel if you were incontinent?” ANS: D The student nurse must become aware of having negative feelings toward incontinent patients to be in a position to change such behavior. One effective approach is to perceive things from the patient’s point of view. Changing an attitude will not automatically change nursing behavior, but the effort to view patients differently may help to achieve this empathic perspective. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 310 PRIORITIZING/ORDERING 4. A nurse disapproves of a patient with diabetes who repeatedly asks for high-calorie snacks that are not within prescribed dietary restrictions. The nurse does not immediately answer this patient’s call bell and avoids going in the room. Arrange in order the steps the nurse should take to change this negative attitude and behavior. A. Problem solve with the patient to develop a realistic dietary plan. B. Directly confront the patient about not adhering to dietary restrictions. C. Attempt to understand what the patient might be thinking and feeling. D. Ask the patient to share feelings about having diabetes and the dietary restrictions. ANS: C, D, B, A To change a negative attitude and behavior, the nurse should first attempt to understand the situation from the patient’s viewpoint. Second, the nurse should provide an opportunity for the patient to share feelings and provide his or her viewpoint. Third, the nurse may directly confront the patient in an empathetic, caring manner. Fourth, the nurse should involve the patient in developing the dietary plan. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 310 MULTIPLE RESPONSE 5. Which client(s) would be most likely characterized as unpopular by the nurse? A. 42-year-old client who has a chronic and persistent mental illness. B. 26-year-old client who is homeless and has psoriasis. C. 64-year-old client hospitalized for 5 months with a spinal cord injury. D. 34-year-old client who is positive despite a diagnosis of breast cancer. E. 52-year-old client who had a stroke and was convicted of a violent crime. F. 92-year-old client who apologizes for requesting assistance to ambulate. ANS: A, B, C, E, Characteristics of clients who are considered unpopular include foreign clients, clients hospitalized longer than 3 months, clients with physical defects, clients with mental illnesses, clients who are homeless, clients who are uncooperative, and clients who interrupt well-established routines and make extra work. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 307 Chapter 28: Managing Team Conflict Assertively and Responsibly Test Bank MULTIPLE CHOICE 1. A staff nurse tells the nurse manager about poor communication that is occurring between nurses when a patient is transferred to another unit. Which response by the nurse manager is best? A. “I doubt this conflict will have an impact on patient care.” B. “Conflict between units is not good and should be avoided.” C. “If this conflict is effectively addressed, patient care can be improved.” D. “What can you do to prevent this conflict from occurring with other nurses?” ANS: C When conflict is effectively addressed, interpersonal relationships and organizational growth can be promoted (e.g., improved patient care). Conflict is often seen as “bad” or inevitable but is a natural part of interactions. Poor communication between units will have a negative impact on patient care. Conflict resolution needs to be handled in an assertive and responsible way and will include more than the actions of one staff nurse. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 315 2. Which conflict would be the most difficult to resolve? A. Staff nurses cannot agree on an outcome for an assigned project. B. Staff nurses argue about the most common adverse effect of a medication. C. Staff nurses disagree on the best method to measure a patient’s temperature. D. Staff nurses have varying beliefs about social justice issues affecting patients. ANS: D There are four categories of conflict intensifying in degree of difficulty from first to last: facts, methods, goals, and values. Differences in belief systems are the most complex type of conflict, and a high level of motivation is required from involved parties to understand each other’s beliefs. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 316 3. Two staff nurses do not agree on who should be the charge nurse. Which approach would lead to a win-win situation? A. The staff nurses take turns so each has the position an equal number of times per year. B. The staff nurse who has seniority is given the charge nurse position. C. Other nurses on the unit decide who will be the charge nurse each shift. D. One staff nurse decides to transfer to another unit to avoid the conflict. ANS: A The win-win approach to conflict resolution results in a solution with which both staff nurses are happy. The other approaches are win-lose; one staff nurse is happy, and the other is not happy. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 317 4. A nurse on an acute care unit focuses on the development of assertive and responsible conflict resolution skills with peers. Which characteristic should the nurse develop? A. Passively participates in discussions. B. Listens empathetically to peers. C. Shares conflict from own point of view. D. Avoids peer assessments of the conflict. ANS: B A win-win approach is assertive and responsible (e.g., listen empathetically to colleagues’ points of view). A win-lose or lose-win approach is nonassertive and irresponsible (e.g., passively participates in information sharing; does not seek out colleagues’ assessments of the conflict; gives defining conflict from own point of view). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 318 PRIORITIZING/ORDERING 5. A nurse manager decides to use a win-win approach to a conflict occurring between the staff nurses and physicians. Arrange the following steps to conflict management in the appropriate order. A. Ask staff nurses and physicians to see the conflict from the other point of view. B. Require that both staff nurses and physicians be actively involved. C. Select a solution that will meet both the needs of staff nurses and physicians. D. Identify the differences between staff nurses and physicians. E. Discuss possible ideas that could resolve the conflict. ANS: B, D, A, E, C A win-win conflict management strategy covers each of the following steps: 1) View the problem in terms of needs; 2) Consider the problem as a mutual one to be solved, requiring the active involvement of all affected; 3) Describe the conflict as specifically as possible; 4) Identify the differences between concerned parties; 5) See the conflict from another point of view; 6) Use brainstorming to arrive at possible solutions; 7) Select the solution that best meets both parties’ needs and considers all possible consequences; 8) Reach an agreement about how the conflict is to end and not recur; 9) Plan who will do what and where and when it will be done; and 10) After the plan has been implemented, evaluate the problem-solving process and review how well the solution turned out. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 317 Chapter 29: Communicating at the End of Life Test Bank MULTIPLE CHOICE 1. A family member of a patient with a terminal disease asks the nurse to explain the difference between hospice and palliative care. Which is the best response by the nurse? A. “A patient must have less than 6 months to live to qualify for palliative care.” B. “Hospice provides support for the patient and family during the dying process.” C. “There is no difference between hospice care and palliative care.” D. “Palliative care provides financial support for patients at the end of life.” ANS: B Hospice is a program of care that supports patients and families during the dying process and in bereavement. Hospice care is usually offered in what is believed to be the last 6 months of life. Palliative care is care of patients whose disease is not responsive to curative treatment. The goal of palliative care is achievement of the best possible quality of life for patients and their families. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 329 2. The nurse notices that a recently hired licensed practical/vocational nurse (LPN/LVN) is reluctant to care for dying patients. Which is the most important questions for the nurse to ask? A. “How do you feel about caring for a dying patient?” B. “Do you want to continue working on this unit?” C. “What patient assignment do you want today?” D. “Have you lost someone you are close to lately?” ANS: B The nurse should explore the LPN/LVN’s feelings about caring for a dying patient. The nurse should avoid asking closed-ended questions or focused questions that do not allow exploration of feelings. It is not within the scope of practice for an LPN/LVN to make patient assignments. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 329 3. The nurse provides information to a daughter about what to expect as her father nears death. Which statement, if made by the daughter, indicates further teaching is required? A. “It is normal for my father to sleep more often.” B. “I will make sure my father drinks enough fluids.” C. “My father’s breathing may stop and start again.” D. “I should continue to talk to my father and hold his hand.” ANS: B Nutrition is less important as the body shuts down, and feeding a person more than desired causes more pain and suffering. A dying patient may nap or sleep most of the day. Breathing may stop and restart or be congested. The dying patient’s sense of hearing may be acute, and the person may feel your touch ; communication should continue until death. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 330 4. The nurse cares for a patient who is hospitalized on the one-year anniversary of the death of her husband. Which statement, if made by the nurse, is most appropriate? A. “I will turn on the television and help you find a favorite program.” B. “I am sure your husband would want you to be happy and not sad.” C. “It is OK to talk to your husband and reflect on how he would respond.” D. “Focus on getting better, and don’t think about your husband today.” ANS: C Holidays or birthdays or the anniversary of the death can be a time that a person becomes clearly aware of the absence of a loved one. The bereaved can be encouraged to talk to the person who has died and listen to what they think would be the response and may suggest reflecting on how knowing the person changed his or her life. Remembering the person who has died is important in the grieving process, and the nurse should not counsel the patient to avoid remembering the person who has died. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 330 MULTIPLE RESPONSE 5. The nurse manager is interviewing several nurses who have applied for a position as a hospice nurse. It is most important for the nurse manager to assess each applicant for which qualities? Select all that apply. A. The nurse tends to patient care needs before personal self-care. B. The nurse is able to compassionately listen to a dying patient. C. The nurse provides care based on the dying patient’s wishes. D. The nurse is able to provide automatic, reassuring responses. E. The nurse is calm and able to create a peaceful environment. ANS: B, C, E The following are examples of essential qualities of a nurse who cares for dying patients: 1) compassionate listening; 2) advocating on behalf of the patient and family; 3) being calm; 4) creating a peaceful environment. The nurse who cares for dying patients should set aside personal discomfort and avoid automatic, reassuring responses. The nurse should pay attention to personal self-care first so that patient care needs can be fully addressed. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 330, 331 Chapter 30: Continuing the Commitment MULTIPLE CHOICE 1. A graduate nurse is concerned about making the transition to nursing practice. It is most appropriate for the graduate nurse to take which action? A. Set professional goals with lofty expectations. B. Ask appropriate individuals for assistance. C. Delay joining professional associations. D. Work extra shifts to gain more experience. ANS: B A proactive approach to making the transition from student nurse to nurse is to identify the appropriate individual to ask for assistance and ask for help. Other proactive approaches include joining professional organizations, setting realistic goals, and focusing on self-care (e.g., stay in contact with friends, take breaks while at work, set a realistic work schedule). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 337 2. Which nurse has achieved generative balance? A. A nurse who sets realistic goals, finds meaning, and renews energy. B. A nurse who controls life events, accepts failure, and seeks perfection. C. A nurse who has high expectations and focuses on professional success. D. A nurse who provides for the needs of others at the expense of self-care. ANS: A Generative balance focuses on three competencies: 1) creating success, 2) finding meaning, and 3) renewal. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 338 3. A nurse educator teaches nursing students about professional communication. Which statement, if made by a nursing student, indicates an understanding of the instructions? A. “If a situation is urgent, the nurse does not focus on communication skills.” B. “Nurses in expanded roles can rely on communication skills learned in nursing school.” C. “Once communication skills are learned, nurses do not need additional education.” D. “Communication requires a commitment to grow, to change, and to be connected.” ANS: D Honest, clear communication takes a commitment to continue to grow, to deal with change, and to stay connected with people. Although nurses function in new and expanded roles in a variety of situations, all maintain the commitment to nursing, to quality patient care, and to lifelong learning. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 340-342 MULTIPLE RESPONSE 4. A nurse who cares for patients in the emergency department is distressed, fatigued, and frustrated by the demands of the job. Which are appropriate methods for the nurse to renew energy and find meaning in nursing practice? Select all that apply. A. Walk briskly with a friend three to four times a week for 30 minutes. B. Start a journal to express feelings of joy, sadness, enthusiasm, or frustration. C. Set aside time with other nurses to complain about problems at work. D. Practice guided imagery or muscle relaxation two times each day. E. Explore other occupations or change jobs every 1 to 2 years. ANS: A, B, D Nurses can renew energy with a body-mind-spirit approach to help deal with workplace stress. Regular physical activity is one approach that is recommended to reduce stress. Self-care strategies can improve the functioning of the mind (e.g., music, movies, reading, journal writing). The spirit can be nourished by setting aside a regular time to contemplate life (e.g., imagery and relaxation). Chronic complaining, leaving nursing or changing jobs frequently are not approaches that renew energy and are signs of burnout. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 340 PRIORITIZING/ORDERING 5. A graduate nurse experiences reality shock when transitioning to a staff nurse position on an oncology unit. Arrange the phases in the order a graduate nurse would experience the reality shock. A. The nurse is frustrated because of time constraints that were not experienced as a student. B. The nurse realizes that there is hope when caring for patients who are dying. C. The nurse experiences energy and excitement when providing nursing care. D. The nurse is able to resolve conflict and identify appropriate and attainable goals. ANS: C, A, B, D The phases of reality shock are: 1) Honeymoon Phase: Enthusiasm, excitement, high energy; 2) Shock Phase: The realization that nursing is not what was expected: anger, frustration, disappointment, fatigue, being critical, having a negative life view; 3) Recovery Phase: A realization that there is more than one perspective in the work situation, returning sense of humor; and 4) Resolution Phase: Choosing a way to resolve the conflict between the subcultures of school and work with different values and emphasis. (Behaviors in this phase may include: frequent job changes; fleeing work by returning to school; quitting nursing; burnout, the result of unresolved work conflict with chronic complaining; or Bicultural Adaptation, a constructive form of resolution which integrates both value systems.) “Honey Shocked, recovered and resolved.” DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 337 42. The nurse is leading a support group for women who have experienced interpersonal violence. When a patient asks about the characteristics of the perpetrators of interpersonal violence, the nurse accurately responds that they are: a. Usually under the influence of alcohol b. Most often someone the victim knows c. A stranger to the victim in most cases d. Often in a psychotic state during the act B *43. To provide nursing care to abused children and their families, the nurse must first: a. Recommend removal of the children from the family. b. Complete a comprehensive physical and mental assessment. c. Refer each case to the appropriate social worker for follow-up. d. Examine personal feelings regarding the trauma of child abuse and neglect. D 44. A patient has been chronically battered by her husband since they were married. Until now she had avoided dealing with her situation, but she now expresses a desire to deal with the problem since the attacks are occurring more frequently. Which outcome is realistic for the patient? a. Setting a goal date for divorcing her husband b. Verbalizing an awareness of her increasingly dangerous situation c. Citing possible ways she may have contributed to the abusive episodes d. Employing methods of retaliating in order to gain experience being assertive  B 45. Which symptom reported by an adult patient, who was sexually abused as a child, reflects the diagnosis of posttraumatic stress disorder (PTSD)? a. A history of substance abuse b. Refusing to go to public places from which escape may be difficult c. Seeking advice and guidance prior to making any significant decision d. Ruminating easily concerning the abuse with friends and acquaintances A 46. A new nurse asks the experienced nurse, “Why did you ask about culture when it was obvious you needed to focus on the battering?” The experienced nurse should respond: a. “It’s just a habit I got into awhile ago.” b. “It helps me focus on whether to do a complete physical assessment.” c. “Culture is a determinant of how women interpret and respond to violence.” d. “If I know more I can refer her to a shelter that caters to her cultural group.” C 47. After being raped, a woman was told by her aunt, “I’m not surprised that happened to you. You always dress to show off your figure.” The victim states, “I can’t believe that people can think that way.” The rape crisis nurse correctly hypothesizes that the patient is: a. Being revictimized by society b. Overly sensitive to others’ views c. Overreacting to not resisting more strongly d. Unaware of the normalcy of male sexual aggression A 48. A patient expresses fear of going home and being alone. Vital signs are stable and the incision is nearly completely healed. What can the nurse infer from the subjective data? a. The patient can now perform the dressing changes without help. b. The patient can begin retaking all of the previous medications. c. The patient is apprehensive about discharge. d. The patient’s surgery was not successful. C 49. While interviewing an older female patient of Asian descent, the nurse notices that the patient looks at the ground when answering questions. What should the nurse do? a. Consider cultural differences during this assessment. b. Ask the patient to make eye contact to determine her affect. c. Continue with the interview and document that the patient is depressed. d. Notify the health care provider to recommend a psychological evaluation. A 50. A nurse is conducting a nursing health history. Which component will the nurse address? a. Nurse’s concerns b. Patient expectations c. Current treatment orders d. Nurse’s goals for the patient B. 51. A nurse is using assessment data gathered about a patient and combining critical thinking to develop a nursing diagnosis. What is the nurse doing? a. Assigning clinical cues b. Defining characteristics c. Diagnostic reasoning d. Diagnostic labeling C. Extra Notes: ➢ The CARE (Clarify, Articulate, Request, Encourage) Confrontation elements are: 1) Clarify the behavior that is problematic; 2) Articulate why the behavior is a problem; 3) Request a change in the client’s behavior; and 4) Encourage the client to change by emphasizing the positive consequences of changing or the negative implications of failing to change. ➢ R.E.A.L. Conversation o Recognize judgements. o Express thoughts neutrally. o Ask questions. o Listen for verbal and nonverbal messages. ➢ Three Criteria for the Appropriate Use of Humor o Timing, Receptivity, Content. Box 4-4 Guidelines for Improving Cross-Cultural Communications (L.E.A.R.N) Listen with sympathy and understanding to the client’s perception of the problem. Explain your perceptions of the problem. Acknowledge and discuss the differences and similarities. Recommend treatment. Negotiate agreement. • Use of professional interpreters, Awareness of volume and tone of voice, use of cultural interpreters for clients (and staff education), Use of silence as a tool. Box 4-3 Guidelines for Communicating with Clients Who are Partially Fluent in English 1. Assess the client’s nonverbal & verbal communication. 2. Keep your eyes at approximately the same level as the clients. This probably means you will sit. Assess whether the client is comfortable with eye contact. 3. Speak slowly and never loudly. (Unless client has hearing impairment). 4. Use pictures when possible. 5. Avoid using technical terms. 6. Ask for feedback. Provide the client with paper & pencil. 7. Remember that clients understand more than they can express. --- they need time to think in their own language. 8. Remember that stress interferes with the client’s ability to think and speak in English. FICA – Taking a Spiritual History ➢ A documented spiritual history is mandated by TJC for clients admitted for care in an acute care hospital or nursing home, & those seen by health agency. ➢ Opens a dialogue about spiritual issues and gives client permission to talk about spirituality with you. ➢ FICA = Faith & Belief. Importance. Community. Address in Care. ➢ Tool is a good way to begin to incorporate spiritual assessment in your work. ➢ Before begining the history taking, it is helpful to explain why you are asking these Qs. o Client may have anxiety thinking you are asking the Qs because of a terminal diagnosis. o Simply let the client know that the Qs you will be asking will allow you to be more sensitive to any spiritual needs a client may have. ➢ Reflect on this mnemonic for fear when you are afraid and in spiritual distress. FEAR is: ➢ F – Forgetting. ➢ E-that everything. ➢ A- is All ➢ R-Right Chapter 18: Using Relaxation Techniques ➢ Relaxation skills are tools for effective stress management, that are a proactive approach to taking responsibility and coming to your work strong and feeling emotionally and physically well. ➢ Resilience = ability to adjust to change, to “bounce back”. ➢ *****H.A.L.T approach for Resiliency and Stress Management ***** o “Know what A stands for” • H = Hungry  Choose nutritious foods. • A = Angry  Deal with fear, frustration, & hurt = emotions that lead to anger. • L = Lonely  Nurture relationships with others. • T = Tired  Commit to getting 8 hours of sleep. Allow yourself time to rest. • Acronym for Hungry, Angry, Lonely, and Tired. • Introduced in Alcoholics Anonymous as a reminder of vulnerabilities that make us less resilient. • Pay attention to your own self-care needs to make the best use of relaxation skills. Importance of Relaxation for the Nurse: ➢ Too much stress affects: o Job safety o Client safety o Driving o Muscle tension ▪ Headaches, soreness, digestive upsets ➢ Relaxation o Focused and alert o Peace and release from tension, anxiety, and fear ➢ Develop a habit of daily relaxation, a letting-go technique to eliminate the negative buildup of stress in your body. ➢ Relaxation practices make you more focused and alert, promoting saftey for clients and yourself! There are benefits for your clients/ colleagues and you when you are more relaxed. ➢ Relaxation is a state of consciousness characterized by feelings of peace and release from tension, anxiety, and fear. ➢ Your own self-caring strategies, mediation and relaxation practices help you build self- awareness and resiliency in times of personal stress and illness. Stressors in Nursing • Agency bureaucracy • Shortage of personnel • Acuteness of clients • Excessive workload • Coordinating of interdisciplinary team • Day-to-day distressing and anxiety-producing situations • Insufficient resources Mediation as a Way to Augment Your Relaxation Response ➢ Mediation is a “mind body practice with many methods and variations… rounded in silence and stillness of compassionate, non-judgemental present-moment awareness.” ➢ Practice of mediation does not require belief in any particular religious or cultural system. ➢ Mediation has become a general term that includes a variety of practices to relax the body and still the mind. ➢ Sense of deep relaxation of body’s musculature; and you can possibly come to know yourself more fully. ➢ Psychologically and physically refreshing & energy restoring. ➢ Learn to diminish your reaction to stressors, you free yourself to deal with aspects of the situation more worthy of your energy. ➢ Mindfulness = Aspect of mediation, that reflects the basic fundamental human capacity to attend to relevant aspects of experience in a non-judgemental and nonreactive way. o Mindfulness cultivates clear thinking, equanimity (composure under stress), compassion and openheartedness. Mindfulness is developed through mediation. ▪ It enables you to maintain a fluid awareness in a moment-by-moment experiential process that helps you disengage from a strong attachment of beliefs, thoughts, or emotions; results in greater sense of emotional balance and well-being. Guidelines for Beginning to Practice Mediation to Elicit the Relaxation Response • Make time  15-20 mins at least once a day. • Set the climate  Find a quiet place in which you will not be disturbed. • Secure a comfortable position  Truly comfortably position. Adjust room temp. • Develop a passive attitude  Let thoughts pass without becoming worried. • Select a mental device  A phrase, word, or sound that you can repeat while you mediate. Called a Mantra, assists in breaking the stream of distracting thoughts. • Relax your body • Focus on your breathing Through your nose and focus on, or become aware of your breathing. • Meditate for 10 minutes  Start by mediating for 10 mins, then 15 or 20. • Experience your unique meditation • End peacefully  Pause before standing and moving. Gently leave your mediation and enter your world refreshed and relaxed. Steps of Progressive Relaxation (Box 18-1) ➢ Method of decreasing muscular tension to promote relaxation response. ➢ Progressively tensing and relaxing muscle sets in a systematic way can be useful for you and your clients. ➢ Favorable results for anxiety, hypertension, insomnia, asthma, dyspnea, and anxiety in chronic pulmonary disease. *******Brief, Practical Strategies for Immediate Relaxation ******* • Deep abdominal breaths • Sprinkling shower: spray from an imaginary shower. • Sunbeam: beam of light or radiant ball just above your head. Feel its protective glow encircling your body. • Safety shield: protective shield. Picture a clear plexi-glass shield that rises up to surround you when you sense danger, with your personal air supply. • Sweeper: magic broom sweeping tension • Massage: Imagining powerful gentle hands massaging tension away ❖ After Each of these techniques, when it is completed, say to yourself, “This is relaxation. This is how it feels to be loose. This is what I want.” o Each of these techniques will relax you and give you inner self-confidence. Stretches to Create Relaxation in Prep for a Stressful Interpersonal Encounter ➢ These exercises involve tensing and relaxing the muscles until you feel the difference between the two sensations and learn to consciously relax any tense muscle. Developing a relaxation response. • High stretch and relax • Shoulder rotation • Shoulder shrug and relax • Arms out, up, and relax Chapter 19: Incorporating Imagery in Professional Practice and Self Care • Image – Mental picture • Visualization – Interchangeable with the term imagery – To visualize is to see or image mentally – The term is used to mean creating an image of something invisible, absent, or abstract ➢ Imagery or visualization is a process of mentally picturing an event we wish will occur in the present or future. ➢ Experiencing a picture that we hold in our mind’s eye. ➢ In visualizing our picture, we may incorporate our senses to taste it, smell it, and feel it, and imagine the sounds and emotions associated with it. ➢ We might mentally rehearse a procedure or scenario. Uses of Imagery in Clinical Practice / Application of Imagery in Healthcare ➢ Imagery creates a bridge between mind and body, linking perception, emotion and psychological, physiological, and behavioural responses. ➢ See positive images of desired outcomes to influence health and well-being. • Imaging positive results can have the opposite effect of the stress response – Promoting relaxation – Helping control blood pressure – Helping to control pain and anxiety – Facilitating the action of medication and treatments – Minimizing side effects – Promoting coping with chronic illness, optimizing healing – Promoting comfort during and after procedures – Use of imagery empowers clients to promote wellness when disease produces a sense of loss of control – Frequent characteristic of executives of major U.S. corporations is that “... They prelived it before they had it.” ➢ Imagery techniques: o End state = Involves the image of a healed state; process which involves imaging step-by-step to a goal. Such as successful, comfortable completion of a procedure. o Active = Involves a conscious choice of a healing image, such as a healing white light directed to the affected area; and anatomic such as imaging of the opening of constricted vessels. ➢ There is evidence that visualization can influence a person’s HR, blood flow, immune response, and total physiology. It is a noninvasive, cost-effective intervention. Implications of Imagery ➢ The mind affects the body and vie versa. ➢ Power that exists within our whole body-mind-spirit beings to heal ourselves. ➢ A simple application of imagery in nursing is the use of alternative language when performing procedures When giving injection, “You may feel a stick” This decreases anxiety and shifts the pattern from response to pain to response to a stick. o Inserting catheter  “You may feel a burning sensation” Brief Imagery Exercises to Cope with Stressful Situations • Intense emotional situations may impair your judgment and make you speak before you think • Relaxing and focusing help to respond rationally rather than react emotionally • Imagine one of the following – A leaf floating downstream – Clouds moving across the sky – Helium-filled balloons rising – Bubbles being blown away Use of Imagery Techniques to Improve Communication Skills • Steps to take to make sure visualization has desired results:  Begin your imagery with 3 deep breaths, so you are relaxed.  Be clear about your desired outcome o Whatever your purpose you must be clear about what you want to happen.  Mentally outline the whole interaction from beginning to end o Visualize prep, beginning, middle, end. By mentally going through the whole encounter, you will be much better prepared.  Concentrate on visualizing details o Environment, how your dressed, posture & facial expressions, composure, use of your senses (listen to what you are saying and how your saying it), envision how you want to feel (calm, confident, competent, compassion), visualize your client’s feelings. – Envision the best and plan for the unexpected o Envision unexpected turns of events you might possibly encounter in reality and practice how to cope with them. o Prepares you for many contingencies. If you have prepared yourself for several versions of what to expect and rehearsed several options, you will feel more confident when In actual situation. – Rehearse repeatedly when necessary o Repeatedly go over the picture of yourself performing successfully in your difficult area. o Repeating will prevent you from getting caught off guard in actual event. You will be able to act instead of react. o If you repeat your positive visualization enough times, you will perform well in reality. – Review your live performance and update your visualization o Take time to evaluate how the session went. o Think back to your rehearsal and notice where you met or surpassed your ideals. o Taking time to commend yourself will increase your self-confidence. ❖ The beauty of mentally rehearsing is that you can repeat it as many times as you like until you get it right! Relationship between Imagery & Interpersonal Communication ➢ Imagery is an invaluable tool for self-direction. ➢ Use the term mental holography to refer to the creation of mental images to enhance communication. ➢ When speakers learn to create sharp, vivid images in their mind, they can better communicate this image via language and body language. ➢ Imagery provides you with a picture of yourself as a nurse who can handle a variety of interpersonal situations confidently and competently. ➢ Having a mental hologram of yourself that envisions how you want to act and be seen supports your success in projecting this image. ➢ You develop a vision of yourself executing the communication behavior you are studying. ➢ You need to create an image that envisions you communicating in a positive, effective, and competent manner. The more detailed & specific you can make your visualization, the more effective it will be to guide your actual communication. ➢ This mental dry run helps cement an image of yourself carrying out the skill correctly. ➢ Seeing yourself perform the way you want to. ➢ Having an image of yourself communicating well makes the future reality of such an event a viable possibility. ➢ Imagery makes you believe that you can achieve your goals. 2 types of Structured Therapeutic Communication: ➢ With AAA ➢ Without AAA o AAA = Acknowledge, Apologize, & Amend ▪ Empathetic technique that helps patients feel heard and understood. ➢ Heart Head Heart Sandwich Communication o Your first communication is from the heart o (I care about you. I want to help.) o Your second communication is from the head o (What I am going to do to fix the problem?) o The final communication is once again from the heart o (It reinforces that I care about you, and I want to help.) Fortinash Violence/Anger Chapter: ➢ Dynamic Nature of Family Violence o Phase I: Assault during courtship and marriage; violence and pregnancy o Phase 2: Assault of women and children o Phase 3: Assault of the elderly 1. A patient is admitted to the hospital with shortness of breath. As the nurse assesses this patient, the nurse is using the process of: A. evaluation. B. data collection. C. problem identification. D. testing a hypothesis.  B 2. The nursing process organizes your approach to delivering nursing care. To provide care to your patients, you will need to incorporate nursing process and: A. decision making. B. problem solving. C. interview process. D. intellectual standards.  C 3. Concept mapping is one way to: A. connect concepts to a central subject. B. relate ideas to patient health problems. C. challenge a nurse’s thinking about patient needs and problems. D. graphically display ideas by organizing data. E. all of the above. E 4. For a student to avoid a data collection error, the student should: A. assess the patient and, if unsure of the finding, ask a faculty member to assess the patient. B. review his or her own comfort level and competency with assessment skills. C. ask another student to perform the assessment. D. consider whether the diagnosis should be actual, potential, or risk.  A 5. A patient is suffering from shortness of breath. The correct goal statement would be written as: A. the patient will be comfortable by the morning. B. the patient will breath unlabored at 14 to 18 breaths per minute by the end of the shift. C. the patient will not complain of breathing problems within the next 8 hours. D. the patient will have a respiratory rate of 14 to 18 breaths per minute. B 6. When caring for a patient who has multiple health problems and related medical diagnoses, nurses can best perform nursing diagnoses and nursing interventions by developing a: A. critical pathway. B. nursing care plan. C. concept map. D. diagnostic label. C 7. Consultation occurs most often during which phase of the nursing process? A. Assessment B. Diagnosis C. Planning D. Evaluation C 8. Nurse-initiated interventions are A. determined by state Nurse Practice Acts. B. supervised by the entire health care team. C. made in concert with the plan of care initiated by the physician. D. developed after interventions for the recent medical diagnoses are evaluated. A 9. You are writing a care plan for a newly admitted patient. Which one of these outcome statements is written correctly? A. The patient will eat 80% of all meals. B. The nursing assistant will set the patient up for a bath every day. C. The patient will have improved airway clearance by June 5. D. The patient will identify the need to increase dietary intake of fiber by June 5. D 10. Your patient has met the goals set for improvement of ambulatory status. You would now: A. modify the care plan. B. discontinue the care plan. C. create a new nursing diagnosis that states goals have been met. D. reassess the patient’s response to care and evaluate the implementation step of the nursing process. B 11. You have finished with several nursing interventions. To evaluate interventions, you need to examine the: A. appropriateness of the interventions and the correct application of the implementation process. B. nursing diagnoses to ensure that they are not medical diagnoses. C. care planning process for errors in other health care team members’ judgments. D. interventions of each nurse to enable the nurse manager to correctly evaluate performance. A