Interpersonal Relationships Professional Communication Skills For Nurses 7th Edition By Boggs Arnold-Test Bank

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Interpersonal Relationships Professional Communication Skills For Nurses 7th Edition By Boggs Arnold-Test Bank

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Interpersonal Relationships Professional Communication Skills For Nurses 7th Edition By Boggs Arnold-Test Bank

Chapter 2: Professional Guides for Nursing Communication

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. The nurse demonstrates effective communication by ensuring all of the following except
a. two-way exchange of information among clients and health providers.
b. making sure that unilateral information is exchanged between clients and nurses.
c. making sure that the expectations and responsibilities of all are clearly understood.
d. recognizing that effective communication is an active process for all involved.

 

 

ANS:  B

Effective communication is defined as a two-way exchange of information among clients and health providers ensuring that the expectations and responsibilities of all are clearly understood. It is an active process for all involved.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 23

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A preoperative assessment shows that a clients hemoglobin level is dropping. The anesthetist orders 3 units of blood to be administered. The nurse administers the first unit before discovering that the client is a Jehovahs Witness, as documented in the record. This is an example of
a. professional conduct.
b. a negligent act.
c. physical abuse.
d. breaching client confidentiality.

 

 

ANS:  B

The nurse was negligent by not checking the record and by failure to obtain written consent from the client for the procedure. This is an example of misconduct, not professional conduct. The nurse did not intend to physically harm the patient. The nurse did not breach client confidentiality.

 

DIF:    Cognitive Level: Application          REF:   pp. 28-29

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following is a violation of client confidentiality? Reporting
a. certain communicable diseases.
b. child abuse.
c. gunshot wounds.
d. client data to a colleague in a nonprofessional setting.

 

 

ANS:  D

Releasing information to people not directly involved in the clients care is a breach of confidentiality. Certain communicable or sexually transmitted diseases, child and elder abuse, and the potential for serious harm to another individual are considered exceptions to sharing of confidential information.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 37

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A 16-year-old trauma victim arrives in the emergency department with a life-threatening condition and requires emergency surgery. The nurse knows that
a. a parent/guardian must give consent.
b. the client can give consent if she provides proof of emancipation.
c. the client must first be evaluated for competency before obtaining consent.
d. surgery can be performed without consent.

 

 

ANS:  D

Surgery can be performed without consent because it is a life-threatening emergency. Normally parents or a guardian must give consent, but in a life-threatening emergency medical care can be administered without consent. Providing proof of emancipation is not necessary in a life-threatening situation. The client does not need to first be evaluated for competency in a life-threatening situation.

 

DIF:    Cognitive Level: Application          REF:   p. 38

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. In regard to informed consent, which of the following statements is true?
a. Only legally incompetent adults can give consent.
b. Only parents can give consent for minor children.
c. It is not required that the client be told about costs and alternatives to treatment.
d. Consent must be voluntary.

 

 

ANS:  D

For legal consent to be valid, it must be voluntary. Only legally competent adults can give consent. Parents or legal guardians can give consent for minor children. Clients must have full disclosure about risks/benefits, including costs and alternatives.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 37

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The client has a living will in which he states he does not want to be kept alive by artificial means. The clients family wants to disregard the clients wishes and have him maintained on artificial life support. The most appropriate initial course of action for the nurse would be to
a. tell the family that they have no legal rights.
b. tell the family that they have the right to override the living will because the patient cannot speak.
c. report the situation to the hospital ethics committee.
d. allow the family to verbalize their feelings and concerns, while maintaining the role of client advocate.

 

 

ANS:  D

Allowing the family to verbalize their feelings and concerns is the most appropriate action at the time to help the family deal with their loss and come to terms with their family members wishes. Telling the family that they have no legal rights would not be supportive and might create hostility. The family does not have the right to override a living will. It is not the most appropriate initial course of action to report the situation to the hospital ethics committee. According to the American Nurses Association Code of Ethics for Nurses, the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

 

DIF:    Cognitive Level: Analysis               REF:   p. 27

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Management of Care

 

  1. The nurse collects both objective and subjective data. An example of subjective data is
a. BP 140/80.
b. skin color jaundiced.
c. I have a headache.
d. history of seizures.

 

 

ANS:  C

Subjective data refers to the clients perception of data and what the client or family says about the data. Objective data refers to data that are directly observable or verifiable through physical examination or tests. Blood pressure recording is objective. Jaundiced skin color observation by the nurse is objective data. A history of seizures is objective data.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 33

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse observes a client pacing the floor. The nurse validates an inference when speaking to the client by stating,
a. You are anxious, so lets talk about it.
b. Lets try some deep breathing to help you relax.
c. You seem anxious. Will you tell me what is going on?
d. Clients who pace usually need to talk to a physician. Should I call yours?

 

 

ANS:  C

The nurse has inferred that the client is anxious but needs to ask further questions to validate the information. A nurse should not make assumptions without first confirming that the inference is correct. Deep breathing exercise is an intervention; it is not validating an inference.

 

DIF:    Cognitive Level: Application          REF:   p. 33

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client who is scheduled for a bilateral inguinal hernia repair the next day is observed pacing the unit. After validating that the client is anxious about his upcoming surgery because he is afraid of pain, a relevant nursing diagnosis would be
a. anxiety related to surgery.
b. pain related to anxiety about surgery as evidenced by pacing.
c. anxiety related to fear of postoperative pain as evidenced by pacing.
d. pacing related to fear of postoperative pain.

 

 

ANS:  C

Anxiety is the problem to be addressed. Related to connects the problem to the etiology (fear of pain). The third part of the statement identifies the clinical evidence (pacing) that supports the diagnosis. There are three parts to a nursing diagnosis, and the anxiety is related specifically to fear of pain after surgery. The problem to be addressed is the anxiety, not the pain, at this time. Pacing related to fear of postoperative pain contains only two parts to this statement. Pacing is the evidence, not the problem.

 

DIF:    Cognitive Level: Application          REF:   p. 33

TOP:   Step of the Nursing Process: Nursing Diagnosis

MSC:  Client Needs: Management of Care

 

  1. Which of the following is an outcome for a client with a broken leg?
a. Client will develop an ambulation program within 1 month.
b. Encourage client to ambulate with cast using crutches.
c. Client asks, When will I walk again?
d. Client experiences alteration in mobility related to a broken leg.

 

 

ANS:  A

Outcomes are goals that are measurable, achievable, and client centered. Ambulation is a nursing intervention. A question from the client is not an outcome; it is a question. Client experiences alteration in mobility related to a broken leg is part of a nursing diagnosis.

 

DIF:    Cognitive Level: Application          REF:   pp. 34-35

TOP:   Step of the Nursing Process: Outcome Identification

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching a client who is alert and oriented about the drug warfarin. When teaching the client about this drug, the nurse emphasizes the need to be consistent with Vitamin K intake, which is found primarily in green leafy vegetables. When the clients spouse comes to visit, the client states, I can no longer consume green leafy vegetables. This is an example of what type of failure caused by a communication problem?
a. System failure
b. Reception failure
c. Transmission failure
d. Global aphasia

 

 

ANS:  B

Communication problems occur when there are failures in one or more categories: the system, the transmission, or in the reception. Reception failures occur when channels exist and necessary information is sent, but the recipient misinterprets the message. System failures occur when the necessary channels of communication are absent or not functioning. Transmission failures occur when the channels exist but the message is never sent or is not clearly sent.

 

DIF:    Cognitive Level: Analysis               REF:   p. 23

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. When setting goals with a client, the nurse demonstrates which step of the nursing process?
a. Assessment
b. Planning
c. Implementation
d. Evaluation

 

 

ANS:  B

Outcome identification occurs during the planning phase. Goals are identified during planning, not assessment. Nursing interventions are performed during the implementation phase. During evaluation, goal achievement is evaluated.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 35

TOP:   Step of the Nursing Process: Outcome Identification and Planning

MSC:  Client Needs: Management of Care

 

  1. When the nurse identifies a health problem or alteration in a clients health status that requires a nursing intervention, the nurse is performing which step of the nursing process?
a. Diagnosis
b. Planning
c. Intervention
d. Evaluation

 

 

ANS:  A

The nursing diagnosis consists of three parts: (1) problem, (2) etiology, and (3) evidence. The problem is a statement identifying a health problem or alteration in a clients health status requiring nursing intervention. Planning occurs after problem identification. Interventions occur during implementation. The effectiveness of the interventions is evaluated in the evaluation phase.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 33

TOP:   Step of the Nursing Process: Diagnosis

MSC:  Client Needs: Management of Care

 

  1. When evaluating the clients progress toward goal achievement, the nurse should ask which of the following questions?
a. Did the client tell the truth?
b. Were the goals realistic?
c. Did the physician diagnose the clients condition correctly?
d. Was the length of stay too short?

 

 

ANS:  B

The goals need to be realistic and achievable in the time frame allotted for the interventions to be effective. Validation of information occurs in the assessment phase. Medical diagnosis is not part of the nursing process. The nurse needs to work within the time frame allotted.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 34

TOP:   Step of the Nursing Process: Evaluation

MSC:  Client Needs: Management of Care

 

  1. The plan of care serves as the structural framework for
a. maintaining confidentiality.
b. attaining self-actualization.
c. maintaining therapeutic communication.
d. providing safe, high-quality care.

 

 

ANS:  D

The plan of care plan serves as the structural framework for providing safe, high-quality care. Its purpose is to provide continuity and supply a basis for interventions and documentation of client progress. Each plan of care should be individualized to reflect client values, clinical needs, and preferences. Confidentiality is defined as providing only the information needed to provide care for the client to other health professionals who are directly involved in the care of the client. The nurse can use Maslows hierarchy of needs to prioritize goals and objectives. Therapeutic communication helps the nurse use the nursing process.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 35

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The nurse is caring for a client whose health has suddenly worsened. The nurse calls the health care provider. What is the best example of the nurse communicating to the health care provider using the situation part of SBAR communication?
a. The patient has developed dyspnea with audible crackles in the lungs bilaterally; oxygen saturation is 86% on room air.
b. The patient has chronic obstructive pulmonary disease due to a long-term history of smoking.
c. I am concerned that the patient is exhibiting signs of a pulmonary embolus due to a sudden drop in oxygenation.
d. I would like for you to order a STAT chest x-ray because the patient has suddenly developed shortness of breath with hypoxia.

 

 

ANS:  A

Situation: What is going on with the client? Background: What is key information/context? Assessment: What do I think the problem is? Recommendation: What do I want to be done?

 

DIF:    Cognitive Level: Analysis               REF:   p. 24

TOP:   Step of the Nursing Process: All phases of the nursing process

MSC:  Client Needs: Management of Care

 

  1. During a routine visit, the nurse notes that a child has several bruises at various stages of healing. The child reports having fallen down. Failure to report these findings is an example of
a. negligence.
b. reasonable prudence.
c. maintenance of confidentiality.
d. HIPAA regulation.

 

 

ANS:  A

Failing to report suspected physical or sexual child abuse is an example of a negligent act. Reasonable prudence is a nursing action that a reasonably prudent nurse would perform. In a situation where a child has several bruises, confidentiality must be breached. HIPAA regulations protect the privacy of client records.

 

DIF:    Cognitive Level: Application          REF:   p. 37

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Management of Care

 

MULTIPLE RESPONSE

 

  1. When practicing effective and correct communication, the nurse should (Select all that apply.)
a. speak in a clear voice.
b. be concise when providing client education.
c. be concrete when communicating with clients.
d. focus entirely on abstract communication techniques with clients.
e. ensure that communication with clients is complete.
f. provide courteous communication when interacting with clients.

 

 

ANS:  A, B, C, E, F

Effective and correct communication is: clear, concise, concrete, complete, and courteous.

 

DIF:    Cognitive Level: Analysis               REF:   p. 23

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

Chapter 12: Communicating with Families

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. Regardless of how uniquely they are defined, strong emotional ties and durability of membership characterize
a. family function.
b. family process.
c. family relationships.
d. family ecomap.

 

 

ANS:  C

A family is who they say they are. Identified family members may or may not be blood related. Strong emotional ties and durability of membership characterize family relationships regardless of how uniquely they are defined. Even when family members are alienated, or distanced geographically, they can never truly relinquish family membership. Family function refers to the roles people take in their families. Family process describes the communication that takes place within the family. An ecomap is essentially a sociogram, illustrating the shared relationships between family members and the external environment. Beginning with an individual family unit or client, the diagram extends to include significant social and community-based systems with which they have a relationship. These data identify at a glance the familys interaction with environmental supports and its use of resources available through friends and community systems.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 217

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. When focusing on family interrelationships and the impact a serious health alteration has on individual family members and the equilibrium of the family system, the nurse should use
a. equifinality.
b. diffuse boundaries.
c. circular questions.
d. morphostasis.

 

 

ANS:  C

Interventive questioning is a nursing intervention that nurses can use with their client families to identify family strengths; help family members sort out their personal fears, concerns, and challenges in health care situations; and provide a vehicle for exploring alternative options.  Questionins can be either linear or circular. Circular questions focus on family interrelationships and the impact a serious health alteration has on individual family members and the equilibrium of the family system. The systems principle of equifinality describes how the same outcome, or end state, can be reached through different pathways. This principle helps explain why some individuals at high risk for poor outcomes do not develop maladaptive behaviors. Boundaries, defined as invisible limits surrounding the family unit, protect the integrity of the family system. Boundaries draw a line in the sand by identifying what belongs within the family system and what is external to it. They define the level of participation between family members. Clear generational boundaries provide security for family members by, for example, setting legitimate limits with children and balancing individual needs with the demands of caring for the needs of chronically ill family members. Boundaries regulate the flow of information into and out of the family. Permeable boundaries welcome interactions with others and allow information to flow freely. Families with clear, permeable boundaries are better able to balance the demands of the illness with other family needs and can communicate more effectively with care providers. Diffuse boundaries lead to family overinvolvement, while rigid boundaries are operative in families with little interaction between members and family secrets. Rigid boundaries restrict flow of information. Interaction with outsiders is discouraged, or heavily regulated. Diffuse boundaries are found in enmeshed families. Morphostasis refers to how the family is able to change and grow over time in response to challenges.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 230

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. A family systems theory that conceptualizes the family as an interactive emotional unit in which family members assume reciprocal family roles, develop automatic communication patterns, and react to each other in predictable, connected ways, particularly when family anxiety is high, was created by
a. Evelyn Duvall.
b. Murray Bowen.
c. McCubbin & McCubbin.
d. Salvador Minuchin.

 

 

ANS:  B

Murray Bowens family systems theory conceptualizes the family as an interactive emotional unit. Bowen believed that family members assume reciprocal family roles, develop automatic communication patterns, and react to each other in predictable, connected ways, particularly when family anxiety is high. Evelyn Duvall proposed a family life stage framework for understanding issues that normal families experience based on expected family development through the life span, each with its own set of tasks. Duvalls model describes the life cycle of a family, using the age of the oldest child in the family as the benchmark for determining the familys developmental stage. Developmental tasks represent the challenges and growth responsibilities each family experiences at different life stages. McCubbin & McCubbins Resiliency Model of Family Stress, Adjustment, and Adaptation is considered the most extensively studied model of family coping with traumatic and chronic illness. In this model, A (an event) interacts with B (resources) and with C (familys perception of the event) to produce X (the crisis). Family structure models, pioneered by Salvador Minuchin, emphasize the structure (subsystems, hierarchies, and boundaries) of the family unit as the basis for understanding family function. Family structure refers to how the family is constructed legally and emotionally. The concept of hierarchy describes how families organize themselves into various smaller units, referred to as subsystems, that compose the larger family system.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 220

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is caring for a client who is extremely dependent on the approval of others, causing them to discount their own needs. The nurse recognizes that the client is demonstrating
a. self-differentiation.
b. emotional cutoff.
c. poor self-differentiation.
d. rigid boundaries.

 

 

ANS:  C

Self-differentiation refers to a persons capacity to define himself or herself within the family system as an individual having legitimate needs and wants. It requires making I statements based on rational thinking rather than emotional reactivity. Self-differentiation takes into consideration the views of others but is not dominated by them. Poorly differentiated people are so dependent on the approval of others that they discount their own needs. Emotional cutoff refers to a persons withdrawal from other family members as a means of avoiding family issues that create anxiety. Emotional cutoffs range from total avoidance to remaining in physical contact, but in a superficial manner. Emotional cutoffs contain a negative anxiety that drains personal energy. The problems creating the emotional cutoff persist. Rigid boundaries are operative in families with little interaction between members and family secrets. Rigid boundaries restrict flow of information. Interaction with outsiders is discouraged, or heavily regulated.

 

DIF:    Cognitive Level: Application          REF:   p. 220

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is caring for a client who reports having marital difficulties. When experiencing heightened anxiety related to his health issues, the client chooses to discuss his feelings with a female friend rather than with his spouse. The nurse recognizes the clients actions as a defensive way of reducing, neutralizing, or defusing heightened anxiety known as
a. systems thinking.
b. triangles.
c. feedback loops.
d. multigenerational transmission.

 

 

ANS:  B

Triangles refer to a defensive way of reducing, neutralizing, or defusing heightened anxiety between two family members by drawing a third person, or object into the relationship. If the original triangle fails to contain or stabilize the anxiety, it can expand into a series of interlocking triangles, for example into school issues or an affair. Systems thinking maintains that the whole is greater than the sum of its parts, with each part reciprocally influencing its function. If one part of the system changes or fails, it affects the functioning of the whole. Feedback loops describe the patterns of interaction that facilitate movement toward morphogenesis, or morphostasis; they impact goal setting in behavior systems. Multigenerational transmission refers to the emotional transmission of behavioral patterns, roles, and communication response styles from generation to generation. It explains why family patterns tend to repeat behaviors in marriages, child rearing, choice of occupation, and emotional responses across generations, without understanding why it happens.

 

DIF:    Cognitive Level: Application          REF:   p. 220

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. When performing an admission assessment on a client, the nurse asks about sibling position based on the knowledge that sibling position can shape relationships and influence a persons expression of behavioral characteristics. The concept that each sibling position has its own strengths and weaknesses is based on the work of:
a. Murray Bowen.
b. Walter Toman.
c. Medalie & Cole-Kelly.
d. McCubbin & McCubbin.

 

 

ANS:  B

Sibling position, a concept originally developed by Walter Toman (1992), refers to a belief that sibling positions shape relationships and influence a persons expression of behavioral characteristics. Each sibling position has its own strengths and weaknesses. This concept helps explain why siblings in the same family can exhibit very different characteristics. Murray Bowens family systems theory conceptualizes the family as an interactive emotional unit. Bowen believed that family members assume reciprocal family roles, develop automatic communication patterns, and react to each other in predictable, connected ways, particularly when family anxiety is high. Medalie and Cole-Kelly describe the course of chronic illness as being a series of crises with relatively stable times in between McCubbin & McCubbins Resiliency Model of Family Stress, Adjustment, and Adaptation is considered the most extensively studied model of family coping with traumatic and chronic illness. In this model, A (an event) interacts with B (resources) and with C (familys perception of the event) to produce X (the crisis).

 

DIF:    Cognitive Level: Application          REF:   pp. 220-221

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. When performing an assessment that focuses on a set of standardized connections to graphically record basic information about family members and their relationships over three generations, the nurse uses
a. an ecomap.
b. a gendergram.
c. family time lines.
d. a genogram.

 

 

ANS:  D

A genogram uses a standardized set of connections to graphically record basic information about family members and their relationships over three generations. Genograms are updated and/or revised as new information emerges. An ecomap is essentially a sociogram, illustrating the shared relationships between family members and the external environment. Beginning with an individual family unit or client, the diagram extends to include significant social and community-based systems with whom they have a relationship. These data identify at a glance the familys interaction with environmental supports and its use of resources available through friends and community systems. Adding the ecomap is an important dimension of family assessment, providing awareness of community supports that are, or are not, being used to assist families. A gendergram is used to understand gender role development in families and its influences on current role enactments. Family time lines offer a visual diagram that captures significant family stressors, life events, health, and developmental patterns through the life cycle. Family history and patterns developed through multigenerational transmission are represented as vertical lines. Horizontal lines indicate timing of life events occurring over the current life span. These include such milestones as marriages, graduations, and unexpected life events such as disasters, war, illness, death of person or pet, moves, or births. Timelines are useful in looking at how the family history, developmental stage, and concurrent life events might interact with the current health concern.

 

DIF:    Cognitive Level: Application          REF:   p. 223

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. When interviewing the family of a client newly diagnosed with Alzheimer disease, the nurses primary goal is to help the family members sort out their personal fears and identify family strengths through the use of
a. interventive questioning.
b. genogram.
c. ecomap.
d. offering commendations.

 

 

ANS:  A

Interventive questioning is an intervention that nurses can use with their client families to identify family strengths; help family members sort out their personal fears, concerns, and challenges in health care situations; and provide a vehicle for exploring alternative options. A genogram uses a standardized set of connections to graphically record basic information about family members and their relationships over three generations. Genograms are updated and/or revised as new information emerges. An ecomap is essentially a sociogram illustrating the shared relationships between family members and the external environment. Beginning with an individual family unit or client, the diagram extends to include significant social and community-based systems with whom they have a relationship. These data identify at a glance the familys interaction with environmental supports and its use of resources available through friends and community systems. Adding the ecomap is an important dimension of family assessment, providing awareness of community supports that are, or are not, being used to assist families. Offering commendations is the practice of noticing, drawing forth, and highlighting previously unobserved, forgotten, or unspoken family strengths, competencies, or resources.

 

DIF:    Cognitive Level: Application          REF:   p. 230

TOP:   Step of the Nursing Process: Interventions

MSC:  Client Needs: Psychosocial Integrity

 

  1. When interviewing the family of a client who is suffering from alcoholism, the communication technique used by the nurse is called circular questioning. The advantage of this technique is that it
a. examines relationships.
b. aids the nurse in establishing a diagnosis.
c. focuses on the equilibrium of the family system.
d. helps the nurse gain specific information.

 

 

ANS:  C

Circular questions focus on family interrelationships and the impact of a serious health alteration on individual family members and the equilibrium of the family system. The nurse uses information the family provides as the basis for additional questions. A technique used to examine relationships is called ecomap. Circular questioning assists the nurse in developing interventions, not diagnoses. Circular questioning helps the nurse gain multidimensional, not specific, information.

 

DIF:    Cognitive Level: Application          REF:   p. 230

TOP:   Step of the Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following describes the dyad family unit?
a. A father and mother with one or more children living together
b. Second- and third-generation members related by blood or marriage but not living together
c. Divorced, never married, separated, or widowed male or female and at least one child
d. Husband and wife or other couple living alone without children

 

 

ANS:  D

A dyad family is a husband and wife or other couple living alone without children. A nuclear family is a father and mother with one or more children living together. An extended family is second- and third-generation members related by blood or marriage but not living together. A single-parent family is a divorced, never married, separated, or widowed male or female and at least one child.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 218

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Management of Care

 

  1. Which of the following is a true statement when comparing biological and blended families?
a. In biological families, rules are varied and complicated.
b. A blended family is born of loss.
c. In biological families, there are multiple sets of rules.
d. In blended families, traditions are shared.

 

 

ANS:  B

In blended families, family is born of loss and rules are varied and complicated. In biological families, one set of family rules evolves. There are two sets of family traditions in blended families.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 219

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Management of Care

 

  1. When the nurse cares for a client with a terminal illness, a question that the nurse can ask the clients family to elicit information about family strengths is
a. Who best understands what the doctors have told you?
b. What has the family been doing so far that is helpful?
c. Who is most uncomfortable at the bedside?
d. Who is now taking care of the house?

 

 

ANS:  B

Questions nurses can use specifically to elicit family strengths include, What has the family been doing so far that has been helpful? Questions regarding level of understanding, comfort, and who is taking care of the house are not the best questions that the nurse can ask the clients family to elicit information about family strengths.

 

DIF:    Cognitive Level: Application          REF:   p. 230

TOP:   Step of the Nursing Process: Interventions

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse-family relationship in client care depends on what type of relationship between the nurse and the family?
a. A dependent relationship
b. A relationship that begins informally
c. A reciprocal relationship
d. A relationship that promotes inequality between the nurse and family

 

 

ANS:  C

The nurse-family relationship in client care depends on a reciprocal relationship between the nurses and family in which both are equal partners and sources of information. The initial encounter sets the tone for the relationship. How nurses interact with each family member may be as important as what they choose to say. The nurse should begin with formal introductions and explain the purpose of gathering assessment data.

 

DIF:    Cognitive Level: Application          REF:   p. 228

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. When caring for clients, it is important for the nurse to understand that
a. treatment plans should be tailored around personal family goals.
b. meaningful involvement in the clients care will be consistent among family members.
c. the nurse should listen to only immediate family members when considering implications for family involvement.
d. individual family members have different perspectives.

 

 

ANS:  D

Meaningful involvement in the clients care not only differs from family to family, it also differs among individual family members. Individual family members have different perspectives. Hearing each family members perspective helps the family and nurse develop a unified understanding of significant treatment goals and implications for family involvement. Although treatment plans should be tailored around personal client goals, acknowledging family needs, values, and priorities enhances compliance, especially if they are different.

 

DIF:    Cognitive Level: Application          REF:   p. 231

TOP:   Step of the Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. The home health nurse is visiting a family who is having difficulty coping. The family has a 2-month-old malnourished child whom they are feeding diluted formula along with rice cereal. The parents of the child are unemployed and are unable to pay their monthly expenses. The father of the child complains of not being able to find a job, while the mother of the child accuses him of not even trying to find employment. Which of the following techniques would be most helpful for the nurse to use in this situation? (Select all that apply.)
a. Linear questioning
b. Interventive questioning
c. Circular questioning
d. Encouraging their coping style
e. Identifying family strengths

 

 

ANS:  A, B, C, E

Interventive questioning is a nursing intervention that nurses can use with their client families to identify family strengths; help family members sort out their personal fears, concerns, and challenges in health care situations; and provide a vehicle for exploring alternative options. Interventive questioning can be either linear or circular. Encouraging the familys current coping style is not useful because it clearly has detrimental effects, including a malnourished child.

 

DIF:    Cognitive Level: Application          REF:   p. 230

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is designing therapeutic interventions for a family whose child is hospitalized with a terminal condition. The nurse recognizes that nursing actions that can be offered to the family that can promote positive change in family functioning include which of the following? (Select all that apply.)
a. Encouraging the telling of illness narratives
b. Commending family on individual strengths
c. Offering information and opinions
d. Discouraging the use of respite care

 

 

ANS:  A, B, C

Suggested nursing actions to promote positive change in family functioning include

  • encouraging the telling of illness narratives.
  • commending family and individual strengths.
  • offering information and opinions.
  • validating or normalizing emotional responses.
  • encouraging family support.
  • supporting family members as caregivers.
  • encouraging respite.

 

DIF:    Cognitive Level: Application          REF:   p. 231

TOP:   Step of the Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

Chapter 26: Communicating at the Point of Care: Application of eHealth Information Technologies

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. When working on a hospital unit, the nurse uses a wireless handheld computer. The nurse recognizes that an advantage of using a wireless handheld computer is
a. the nurse cannot view the entire page of client information.
b. it can be used at the point of care.
c. it has a long learning curve.
d. it poses potential threats to the clients legal privacy rights.

 

 

ANS:  B

An advantage to using wireless handheld computers is that they are easily portable and can be used at the point of care (e.g., at clients bedside, in the home). Disadvantages to using wireless handheld computers include the nurse not being able to view the entire page of client information, a long learning curve, and the potential threat to the clients legal privacy rights.

 

DIF:    Cognitive Level: Application          REF:   p. 509

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. When working on a hospital unit, the nurse uses a cellular telephone as an aid to giving client care. When using a cellular telephone, the nurse recognizes that a barrier to this type of technology is
a. cellular telephones lead to less productivity.
b. cellular telephones can lead to a higher rate of hospital errors.
c. some hospitals prohibit using cellular telephones.
d. cellular telephones complicate information retrieval at the point of care.

 

 

ANS:  C

Although just about every nursing student has seen or used a wireless or cellular telephone, not everyone has used them as an aid to giving client care. There are still hospitals that prohibit nurses from using cell phones, even though studies show these devices can save time, decrease errors, and simplify information retrieval at the point of care. Nursing is just beginning to deal with guidelines. Ethically, you do not use electronic devices in your workplace for personal, nonprofessional use. All information needs to be HIPAA secure.

 

DIF:    Cognitive Level: Application          REF:   p. 512

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. When working on a hospital unit, the nurses use a voice communication system that uses the existing wireless network to support instant voice communication and messaging among staff within the agency. Using this device allows nurses to connect to the telephone system and to access other users of the system through a small, one-button, voice-access, lightweight badge. This device is known as
a. a PDA.
b. Vocera.
c. a smartphone.
d. telehealth.

 

 

ANS:  B

Voice communication systems use wearable, hands-free devices that use the existing wireless network to support instant voice communication and messaging among staff within an agency. The nurse wears a small, lightweight badge that permits one-button voice access to other users of the system. It also will connect to the telephone system. One example is Vocera. It is said to reduce the time for key communications, such as looking for the medication keys, looking for others (a 45% reduction), paging doctors, or walking to the nursing station telephone (a 25% reduction). Nurses report that voice-activated communication facilitates communication, results in fewer interruptions, promotes better continuity of care, and improves their workflow. Personal digital assistants (PDAs) are handheld electronic devices that may contain multiple databases, possibly including a language translator for use when interviewing a patient from another culture. Smartphones represent the convergence of cellular mobile phones and mobile computers. These devices, such as the Blackberry, have three functions. They enable one to download and access PDA-type information resources, provide Internet access to client information [new lab results or physician orders], and make and receive telephone calls or instant messages. Telehealth provides live, real-time audio and visual transmissions from one care provider to another or to a client. This technology is hailed as a boon to rural practitioners, facilitating long-distance consultations by expert specialists. Telehealth nursing communicates monitoring data to the nurse from the client.

 

DIF:    Cognitive Level: Application          REF:   p. 515

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. When caring for a client who is at risk for falls, the nurse recognizes that a system that communicates whether the client falls and does not get up via sensors embedded in the hospital room is referred to as
a. telecare.
b. health information technology.
c. radio frequency identity chips.
d. a personal digital assistant.

 

 

ANS:  A

Telecare refers to telemetry that communicates client vital signs, monitors whether nurses wash hands, or signals if a client falls and does not get up via sensors embedded in the hospital room or clients house. Families in America and England are using such sensors placed throughout the clients home to monitor for potential problems such as stove burners left on, doors left open, a too cold house, or a client crisis, such as an epileptic seizure. In the literature, these are referred to as Smart Rooms, a form of automated medical technology.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 514

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The nurse is teaching a group of nursing students about an umbrella term for services that use communications technology, defined as any real-time interactive use of the Internet for delivery of health care from a distance using telecommunications technologies. This term is known as all of the following except
a. telehealth.
b. telenursing.
c. telemetry.
d. telemedicine.

 

 

ANS:  C

Telehealth is also called telemedicine, telenursing, or eHealth (in England). It is an umbrella term for services that use communications technology, defined as any real-time interactive use of the Internet for delivery of health care from a distance using telecommunications technologies.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 514

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following is true about electronic mail communication?
a. Most physicians use e-mail to schedule appointments.
b. E-mail is a means of ensuring confidentiality.
c. Physicians expressed concerns about lack of income generation.
d. Paper copies can be eliminated.

 

 

ANS:  C

E-mail can be a convenient, rapid, inexpensive method of communicating between providers and clients. Yet, while most clients express a desire to communicate with their health care providers via e-mail, only about 72% of physicians in large medical centers reported using this method of communication. Barriers include concern about lack of income generation, confidentiality, malpractice, and time factors. Office nurses use e-mail for scheduling appointments, posting test results, providing prescription refills, and other health reminders. Nurses also use e-mail for education or follow-upfor example in tracking the response of clients who are on new medication, instead of waiting until their next office appointment. AMA guidelines suggest that electronic or paper copies be made of e-mail messages sent to clients.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 517

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A nursing instructor educates a student nurse about standards of effective communication. The nursing instructor recognizes that additional teaching is warranted when the student nurse lists which of the following as a standard of effective communication?
a. Clear
b. Timely
c. Lengthy
d. Complete

 

 

ANS:  C

Standards of effective communication include communication that is complete, clear, brief (not lengthy), and timely.

 

DIF:    Cognitive Level: Application          REF:   p. 511

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The nurse is teaching a class on stroke prevention. Which of the following statements is accu

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