The nurse manager calls a meeting of members of the nursing team to resolve problems surrounding
patient complaints of slow and sometimes discourteous responses to requests. What role does problem
resolution play in this communication?
Situational context involves the reason for communication, which is problem resolution in this instance.
Relational context indicates the nature of the relationship among participants, such as a social, helping,
or working relationship. Environmental context involves the physical surroundings in which
communication occurs. The psychophysiological context involves internal factors affecting
communication, such as physiological status and emotional status.
While interacting with a woman who underwent a mastectomy, the nurse says, "I'm worried that you
might feel devastated after your surgery." Which nontherapeutic communication technique does the
nurse exhibit?
Sympathy is the nontherapeutic communication technique exhibited by the nurse in this scenario.
Sympathy is concern, sorrow, or pity felt for another person. Sharing humor is a therapeutic
communication technique. Humor is an important, but often underused, resource in nursing
interactions. Sharing feelings is a therapeutic communication technique. Sharing feelings can be a
therapeutic communication technique; feelings are not right, wrong, good, or bad, although they may be
pleasant or unpleasant. Giving personal opinions is a nontherapeutic communication technique in which
the nurse injects his or her own views regarding care options; this may serve to take decision-making
power away from patients.
n the communication process, who is the receiver of the message?
Communication is an active process between a sender and a receiver. The receiver is the person who
receives and decodes a message. The receiver also provides feedback to the sender. The sender is the
person who encodes and delivers a message. The sender also seeks both verbal and nonverbal feedback.
The nurse is caring for patients in a hospital setting. Which actions would the nurse perform during the
working phase of a helping relationship?
The working phase of a helping relationship involves nurses working together with patients to set their
goals and encouraging them to solve their problems and express their feelings. This phase also involves
helping patients take actions to meet their goals. Reviewing patients' medical data is part of the
preinteraction phase of the helping relationship. Assessing patients for their health status is part of the
orientation phase in which the nurse and the patients get to know each other.
Which is a nontherapeutic communication technique?
Nurses may take patient feelings on as their own, which may hinder the nurse's ability to be objective
and help the patient process their feelings. Focusing is a therapeutic communication technique that
involves centering a conversation on key elements or concepts of a message. Clarifying is therapeutic
communication technique to check whether you understand a message accurately by restating an
unclear or ambiguous message to clarify the sender's meaning. Summarizing is a therapeutic
communication technique that involves a succinct review of key aspects of an interaction.
p. 331
An elderly patient who is critically ill asks the nurse about assisted suicide. The nurse is ethically opposed
to assisted suicide. Which is the most appropriate response by the nurse?
When there is a difference of opinion between the nurse and the patient, it is important for the nurse
not to force ideas on the patient. Instead of showing disapproval, the nurse should try to know more
about the situation and explore the patient's views. Telling the patient not to think about it would
prevent the patient from communicating further. It is an unethical nursing practice for the nurse to tell a
patient that the nurse does not want to talk about the topic. Telling the patient that it is a bad idea
would offend the patient and prevent the patient from opening up.
The nurse summarizes a conversation with the patient to determine whether the patient has understood
the nurse. Which element of the communication process does this illustrate?
Feedback is the message the receiver returns that indicates understanding. By summarizing what the
patient has said, the nurse can determine whether the message was received accurately. A referent
motivates one person to communicate with another. Communication channels are means of sending and
receiving messages through visual, auditory, and tactile senses. The environment is the setting for
sender-receiver interaction.
A registered nurse (RN) is teaching a nursing student about the different assessments required while
communicating throughout the nursing process. Which statement by the nursing student indicates the
need for further teaching?
Documenting the nursing diagnostic procedure is included under the nursing diagnosis phase of
communicating throughout the nursing process. Verbally communicating or discussing with the health
care team is included under the implementation phase. Verbally interviewing and asking for history is an
effective form of communication. Visually observing the nonverbal behavior of others and gathering data
during physical examination are also included in effective communication.
The registered nurse (RN) is teaching a nursing student about nonverbal skills that facilitate attentive
listening while interacting with the patient. Which statement by the nursing student indicates the need
for further teaching?
Nonverbal skills enhance trust and helps the nurse communicate acceptance and respect for a patient. It
is important to lean toward the patient and not away from the patient, because this position conveys
that the nurse is involved and interested. The nurse should sit in an open position by keeping her or his
arms and legs uncrossed, because this position suggests that the nurse is "open" to what the patient
says. A "closed" position, such as crossing arms, conveys a defensive attitude. It is essential to sit facing
the patient, because this posture conveys the message that the nurse is there to listen to what the
patient is saying. The nurse should maintain intermittent eye contact to convey involvement in and
willingness to listen to what the patient is saying. It is important to communicate with a sense of being
relaxed and comfortable with the patient.
The patient has just been told that she has cancer, and she is crying. Which actions facilitate therapeutic
communication?
Privacy and lack of distraction create an environment conducive to therapeutic communication. Nursing
presence and touch convey caring and compassion and allow the patient to collect her thoughts.
Providing information tells people what they need or want to know. "Why" questions may seem intrusive
and block communication.
Which statement would be most likely to block communication?
Avoid asking "why" questions. They tend to imply an accusation and can build resentment.
A 35-year-old athlete becomes aggressive when not allowed to be ambulatory due to a fractured leg.
The patient tries to get out of the bed unattended and falls. The nurse tries to explain the importance of
immobilization. The nurse explains that walking and putting weight on the fractured leg may cause more
injury and worsen the condition. Which nontherapeutic techniques should the nurse avoid while
communicating with the patient? .
Giving false reassurance to the patient about the situation is unethical and may cause the patient to lose
trust in the nurse. Responding with aggression, such as by exhibiting anger and frustration, is
unprofessional behavior. Asking the patient for explanations might be interpreted by the patient as
accusatory and may interfere with communication. Sharing hopes and feelings, listening actively, and
clarifying are therapeutic communication techniques.
The nurse works in a nursing home and understands that most of the elderly patients have varying
degrees of hearing loss. Which interventions would help the nurse to communicate with these patients?
Speaking clearly and slowly gives the patient time to comprehend what the nurse is saying. Patients who
have hearing aids are encouraged to use them to improve communication. When patients are aware that
the nurse is talking, they are more attentive and try to comprehend better. Speaking quickly will not
encourage effective communication; rather, speaking slowly and being patient will help. The nurse
should face the patient and make sure that the patient can see the nurse's mouth when speaking.
The registered nurse (RN) is communicating with a patient in the surgical unit. Which statement by the
RN indicates the technique of sharing hope?
Stating that the patient is a fighter and will find a way to face the condition is an example of the
therapeutic communication technique of sharing hope. Stating that the patient seems cheerful indicates
the therapeutic communication technique of sharing observations. Stating that the patient might be
irritated by being bedridden for a month due to a leg fracture indicates the therapeutic communication
technique of sharing empathy. Instructing the patient to walk for five minutes, as suggested by the
primary health care provider, indicates the therapeutic communication technique of sharing
observations.
Which special zone of touch requires special care?
Vulnerable zones of the body like the face, neck, and front of the body require special care. Social zones
like hands, arms, shoulders, and back do not need any permission for touching. The consent zone
includes the mouth, wrists, and feet and needs permission for touching. Great sensitivity is needed while
touching the intimate zone like the genitalia and rectum.
The nurse is planning to conduct an interview of a Portuguese patient who does not speak English. The
nurse has arranged for an interpreter, who is currently in the patient's room. The nurse speaks to the
interpreter directly and maintains eye contact. The interpreter then translates the information for the
patient. What can be said about the communication pattern used by the nurse?
It is very important to have interpreters present when conducting interviews with patients coming from
non-English-speaking backgrounds. The nurse should speak directly to the patient even if the interpreter
is present. This shows that the nurse respects and cares for the patient. The nurse should not speak to
the interpreter. The nurse should maintain eye contact with the patient. Conducting the interview in the
presence of the caregivers would be an invasion of the patient's privacy.
The nurse asks another nurse how to collect a laboratory specimen and is told, "Why don't you figure it
out?" Which would be the best response?
Lateral violence can be dealt with by using assertive communication. Simple assertive statements include
referencing the person you are addressing, the behavior that is a problem, and its effect. Avoiding the
situation, becoming defensive, or making sarcastic remarks does not help to resolve the problem.
pp. 323-324
The nurse explains to a patient that self-talk can improve self-awareness and help build a positive self-
concept. To which level of communication does this refer?
Intrapersonal communication is a form of communication that occurs within an individual. This can also
be referred to as self-talk or self-verbalization. Interpersonal communication occurs on a one-on-one
basis between the nurse and the patient. Transpersonal refers to communication that occurs within the
spiritual domain, and small-group communication occurs in a group.
Test-Taking Tip: To help you remember the meaning of intrapersonal, recall that intramural sports are
played by teams within the same school. Intra- means within, so intrapersonal takes place within an
individual.
Which behaviors foster the development of trust
Consistency, courtesy, competency, and honesty build trust. Rushing and avoiding spending time with
the patient may decrease or slow the development of trust.
The nurse and a patient are talking about a baseball game. Both of them are using the word baseball to
refer to the sport. Which best describes the use of the word baseball in this context?
A word that has the same meaning for all people who speak the same language is considered denotative.
The dictionary meaning of the word baseball is denotative. A connotative meaning is influenced by the
thoughts, feelings, or ideas of individuals. Intonation refers to the tone of voice. Metacommunication
refers to all factors influencing communication.
The nurse is caring for a 65-year-old patient who is visually impaired. Which communication strategies by
the nurse would demonstrate a lack of competence?
When the nurse is caring for a visually impaired patient, it is effective to use indirect lighting and to avoid
glare. It is recommended to use at least 14-point type when providing reading material to a visually
impaired patient. Do not rely on gestures or nonverbal communication while communicating with
visually impaired patients. Make sure that the patient is using glasses or contact lenses. The nurse should
communicate in a normal tone of voice.
Which form of communication is appropriate to assess understanding and clarify misinterpretations
when the nurse is teaching a patient about a health concern?
Interpersonal communication is one-on-one interaction between a nurse and another person that often
occurs face-to-face. This interaction is useful to assess understanding and clarify misinterpretations when
teaching a patient about a health concern. Public communication is interaction with an audience. Nurses
often speak with groups of consumers about health-related topics. Small group communication occurs
when a small number of people meet. This type of communication is usually goal directed and requires
an understanding of group dynamics. Intrapersonal communication is a powerful form of communication
that you use as a professional nurse. This level of communication is also called self-talk.
The nurse is practicing active listening when conducting a patient interview. The nurse sits facing the
patient with legs and arms crossed. The nurse leans towards the patient and maintains intermittent eye
contact while listening. What can be concluded about the nurse's active listening skills?
It is inappropriate for the nurse to cross legs and arms while listening to the patient. This posture creates
distance and indicates defensiveness, which can shut down communication. The nurse should have an
open posture. Active listening indicates being attentive to the patient both verbally and nonverbally. This
builds a trustworthy relationship between the patient and the nurse. Leaning towards the patient
indicates that the nurse is listening to the patient. Maintaining intermittent eye contact indicates active
listening.
Which special zone of touch is involved during teeth replacement?
The consent zone of touch is a special zone that is involved during tasks such as replacing teeth. This
zone requires permission for touching. The social zone is a special zone that does not require permission
for touching; it includes the arms, hands, shoulders, and back of patients. The intimate zone is a special
zone that requires great sensitivity. The vulnerable zone is a special zone that needs special care.
A 40-year-old patient is suffering from poorly controlled hypertension. The dietitian recommended
several dietary modifications to the patient. Which techniques should the nurse use during the
orientation phase of this helping relationship? .
In the orientation phase of building a helping relationship, the nurse should closely observe the patient
and prioritize the patient's problems. The nurse should create a warm and empathetic conversation and
work to understand the patient's behavior. Reviewing the patient's medical history and choosing a quiet
setting for the conversation are techniques used in the preinteraction phase.
The nurse is caring for an 80-year-old woman and asks the patient a question while the nurse is across
the room washing hands. The patient does not answer. What is the nurse's next action?
The nurse should not assume that the patient is hard of hearing because she is 80, but it is more likely.
The patient may have not responded because the nurse was across the room and water was running.
The nurse should not jump to conclusions, but instead try again to communicate with patient as with
someone who is hard of hearing.
The nurse is performing the initial assessment of a patient who is experiencing difficulty articulating
words. Which etiological factors may lead to this condition?
Facial trauma can cause damage to the facial muscles and surrounding structures, restricting their
movements and causing difficulty in articulating words. Laryngeal cancer affects vocal cords and the
passage of air through them, which causes articulation difficulties. Endotracheal intubation prevents air
from moving through vocal cords and restricts tongue movements. Acne is a skin condition and is not
related to articulating words. Intravenous catheterization, which is generally done in the limbs, is not
related to articulating words, unless there is some underlying complication.
Which nursing interventions help the nurse establish a therapeutic relationship while working with a
patient to solve problems and accomplish goals?
here are four phases of therapeutic relationship building in clinical nursing practice. The working phase
starts when the nurse and patient work together to solve problems and accomplish goals. In this phase,
the nurse provides encouragement and helps the patient set goals that are achievable. The nurse
initiates action and encourages the patient to implement those actions. The working phase helps the
nurse to meet the goals set with the patient. The nurse also provides information that the patient needs
to understand to change behavior in order to achieve optimal health. The nurse should assess the
patient's health status in the orientation phase, which helps the nurse to understand the patient's needs
and requirements. The nurse discusses the patient with other caregivers before meeting the patient in
the preinteraction phase, not in the working phase.
The nurse is caring for a Spanish-speaking patient with a hand fracture. Which approaches are likely to
be ineffective when communicating with the patient?
While caring for a non-English speaking patient, a professional interpreter should be provided; a family
member should not be used as an interpreter. Nodding or making statements such as "OK" are not
necessarily indications of understanding. It is necessary to assess the patient's primary language and
level of fluency in English. Incorporating the patient's communication methods or need into plan of care
is an important action. Providing written information in English and in the primary language of the
patient is an essential action while communicating with a non-English speaking patient.
A patient with limited English proficiency is going to be discharged on new medication. How should the
nurse complete the discharge teaching?
t is essential that patients understand discharge instructions to safely care for themselves at home.
Patient who have limited ability to speak or understand English have a legal right to an interpreter to
ensure understanding of essential information. An interpreter, more so than using a dictionary, a family
member, or a picture board, will.
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