Basic Geriatric Nursing 6e Williams – Test Bank

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Chapter 05: Communicating with Older Adults

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following best defines therapeutic communication?
a. Has a specific intent or purpose
b. Is the only form of professional communication
c. Should never be used in a social setting
d. Requires no special skills, just a willingness to listen

 

 

ANS:  A

Therapeutic communication is a style of conversation between the nurse and the patient in which there is a specific purpose or intent.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 88               OBJ:   5

TOP:   Therapeutic Communication            KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. Why is it important for the nurse to be cautious when using medical jargon with an older adult patient?
a. It could become an opportunity to instruct the patient.
b. It could become an effective abbreviated communication shortcut.
c. It could become an indicator of formal communication.
d. It could become a communication barrier.

 

 

ANS:  D

The use of jargon can become a barrier because the patient may not understand and would be unwilling to disclose ignorance of terms. Habitual use makes health professionals less sensitive to persons who may not be familiar with the terms.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 89               OBJ:   1

TOP:   Communication Barrier                   KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The nurse is engaging the patient in social conversation. What is the benefit of social conversation in the health care setting?
a. It lets the patient know that he or she is considered to be a person, not just a patient.
b. It encourages sharing of intimate details.
c. It establishes the nurse’s role as a health care provider.
d. It blocks more meaningful therapeutic communication.

 

 

ANS:  A

Social conversations establish that the nurse considers the patient a person in his or her own right. Such conversation is valuable for the nurse to discover information about the patient as a person and for the patient to discover information about the nurse as a person.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 90               OBJ:   1

TOP:   Social Conversation                        KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. What can the nurse do to improve communication with an older adult patient who has a hearing impairment?
a. Speak in a higher tone, standing directly in front of the patient.
b. Speak more loudly from several feet away.
c. Speak normally with exaggerated hand gestures.
d. Speak in a low tone, bending close to the patient.

 

 

ANS:  D

Speaking in a low tone and bending near the patient is a more effective way to communicate with the hearing-impaired.

 

DIF:    Cognitive Level: Application           REF:   p. 91               OBJ:   1

TOP:   Communicating with the Hearing-Impaired

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. Seeing a patient with his head in his arms resting on the over-the-bed table, the nurse steps into the room and asks if the patient feels ill. The patient, without raising his head, says, “I’m fine.” What would be an appropriate response of the nurse?
a. Sit down next to the bed and say, “You don’t act fine.”
b. Pat him on the shoulder and continue on rounds.
c. Say, from the doorway, “If you need anything, just call me.”
d. Assist the patient to sit up and say, “Now, that’s much better, isn’t it?”

 

 

ANS:  A

Reading the body language that says “I’m not fine,” the nurse should enter the room and be seated to demonstrate willingness to listen.

 

DIF:    Cognitive Level: Application           REF:   p. 91               OBJ:   3

TOP:   Body Language                               KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. When entering the room of an older adult to insert a catheter, what would be the most effective approach by the nurse?
a. Touch the patient and say, “I need to insert this catheter.”
b. Approach the bed, turn back the cover, and announce, “The doctor wants a urine specimen.”
c. Open catheter tray at bedside, turn back the cover, and say, “Is it okay to put a tube in your bladder?”
d. Introduce yourself at the door and ask, “May I insert this catheter for a urine specimen?”

 

 

ANS:  D

Speaking to the patient from a public space and requesting permission to do a procedure is the best approach. All other options indicate, by the nurse’s nonverbal communication, that permission is not really required before insertion.

 

DIF:    Cognitive Level: Application           REF:   p. 91               OBJ:   3

TOP:   Invading Space                               KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. What is the best method of communication for a patient with aphasia?
a. A notepad
b. Speaking slowly
c. Worded flash cards
d. Gestures

 

 

ANS:  D

Gestures and/or symbols are helpful for persons with aphasia because they cannot recognize the spoken or written word.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 91-92        OBJ:   3

TOP:   Use of Gestures                               KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The white female nurse is concerned that the 80-year-old African-American male patient is not being truthful with her because of his
a. lack of eye contact.
b. smiling facial expression.
c. tone of voice.
d. body language.

 

 

ANS:  A

The nurse needs to be aware that African Americans, particularly older adults, limit eye contact as a sign of respect.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 92               OBJ:   6

TOP:   Eye Contact    KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. When asked about the severity of pain, the 93-year-old patient does not answer right away. What is the best response by the nurse?
a. Ask rapid questions: “Is it better? Is it worse than yesterday? Is it worse than this morning?”
b. Repeat the question in a louder voice.
c. Say, “You must be feeling better because you’re not complaining.”
d. Keep eye contact and wait for the answer.

 

 

ANS:  D

Empathetic listening is the key to maintaining good communication with the older adult who may need longer time to form a response.

 

DIF:    Cognitive Level: Application           REF:   p. 92               OBJ:   2

TOP:   Active Listening                              KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. When the nurse answers the call light after a delay of 5 minutes, the angry patient says, “You made me wait an hour. I’m in pain and no one’s willing to help me.” What is the best response by the nurse?
a. “It’s only been 5 minutes. What do you want?”
b. “Well, I’m here now. What is your problem?”
c. “I know it must have seemed like an hour. I’ll bring your medication.”
d. “I was attending to another patient who’s really ill. I’ll help you now.”

 

 

ANS:  C

Many older adults have an altered sense of time. Waiting makes them more anxious. Responding in a defensive or grudging manner is not effective for the nurse-patient relationship.

 

DIF:    Cognitive Level: Application           REF:   pp. 92-93        OBJ:   4

TOP:   Timing           KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The 93-year-old woman with chronic back pain is found crying. When the nurse approaches, the patient says, “I know you can’t do anything more, but I hurt so bad.” What nursing intervention would be most effective?
a. Bring pain medication when it is time for it.
b. Assure the patient that the pain medication will take effect soon.
c. Touch the patient’s shoulder and sit quietly without speaking.
d. Distract the patient by offering a sip of water.

 

 

ANS:  C

Use of empathetic touch is a message of comfort. The other options do not address the patient’s distress relative to unrelieved pain.

 

DIF:    Cognitive Level: Analysis                REF:   p. 93               OBJ:   3

TOP:   Silence           KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The nurse is entering the room of a new 85-year-old female patient to complete the admission process. How should the nurse initiate the conversation?
a. “Good morning, Mary. We need to get some questions answered.”
b. “Welcome to 4B, Mrs. Miller. I’d like to get some additional information, if I may.”
c. “Hello, sweetie. I’ll bet you thought all the admission stuff was finished, didn’t you?”
d. “I need to finish the admission. What is your name?”

 

 

ANS:  B

Using a formal address is a respectful way to start a conversation with a new patient. If the patient prefers to be called something else, he or she can inform the nurse of that desire.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 93-94        OBJ:   1

TOP:   Respect          KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The nurse is informing a patient about an upcoming diagnostic procedure.  What statement by the nurse would demonstrate effective communication?
a. “Mr. Brown, your leg is to be x-rayed in the x-ray department in an hour.”
b. “X-ray is coming to get you for an AP and lateral of your chest.”
c. “You can’t eat anything after supper because of some lab work.”
d. “Mrs. Smith, the OR has notified us that they’re running behind.”

 

 

ANS:  A

Clear, concise information in words that the patient can understand is the most effective method for providing information.  Medical jargon should be avoided.

 

DIF:    Cognitive Level: Application           REF:   p. 94               OBJ:   4

TOP:   Informing       KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. What is true of direct questions?
a. They can get a lot of information quickly.
b. They can help the patients organize their thoughts.
c. They get minimum response answers of “yes” and “no.”
d. They make patients think that they are contributing to their health care.

 

 

ANS:  C

The diminished, overwhelmed patient will give minimal answers to direct questions if the technique is overused. The technique is best used to obtain factual information.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 97               OBJ:   4

TOP:   Direct Questions                             KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The patient denies smoking, although the smell of tobacco is strong in his hospital room. Which of the following statements by the nurse would be the most effective?
a. “Don’t bother to lie to me. I know you’ve been smoking.”
b. “It is very dangerous to smoke in bed.”
c. “The hospital has policies against smoking.”
d. “I can smell the tobacco, and I see your lighter on the bedside table.”

 

 

ANS:  D

Identifying evidence in a nonaccusatory manner establishes the point of discrepancy. Belittling the patient or quoting policy is not effective.

 

DIF:    Cognitive Level: Application           REF:   pp. 98-99        OBJ:   4

TOP:   Confrontation                                  KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. When the nurse is inquiring about the patient’s level of pain, which of the following statements would best support the patient?
a. “Does your stomach hurt now?”
b. “How would you describe your pain?”
c. “When the pain occurs, does the medicine help?”
d. “Do you use more than one pain remedy?”

 

 

ANS:  B

Open-ended questions allow the patient to give more elaborate answers.

 

DIF:    Cognitive Level: Application           REF:   p. 97               OBJ:   4

TOP:   Open-Ended Questions                    KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The patient says, “When I came to the hospital yesterday, everything got confused.” What would be the best response by the nurse?
a. “What happened?”
b. “Yes, hospital admissions can be confusing.”
c. “Are you confused now?”
d. “We really try to make admissions less stressful.”

 

 

ANS:  A

Clarifying an unclear statement with the use of an open-ended query is helpful to providing better communication.

 

DIF:    Cognitive Level: Application           REF:   p. 97               OBJ:   4

TOP:   Clarification   KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. What percent of communication is transmitted by verbal methods?
a. 7
b. 18
c. 22
d. 36

 

 

ANS:  A

It is estimated that only about 7% of communication is transmitted by verbal methods. Nonverbal communication is the most effective method of communicating.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 89               OBJ:   3

TOP:   Nonverbal Communication              KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. What is the goal of empathetic listening?
a. It encourages the patient to divulge information.
b. It allows for time to pose another question to the patient.
c. It indicates the conversation has come to a close.
d. It allows the nurse to interpret what the patient has said.

 

 

ANS:  D

Empathetic listening is a skill that helps the nurse interpret what the patient is saying. A nurse has not really listened until the nurse has understood what was intended by the speaker.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 93               OBJ:   2

TOP:   Empathetic Listening                       KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When using an interpreter to speak with an 84-year-old Chinese patient, on what should the nurse focus?
a. The patient, not the interpreter
b. Encouraging the interpreter to paraphrase
c. Limiting questions from the patient
d. Listening to the words, not emotional tone

 

 

ANS:  A

The nurse using an interpreter should focus on the patient and the patient’s emotional tones, not the interpreter. The patient should be encouraged to ask questions. The interpreter should not paraphrase.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 96               OBJ:   6

TOP:   Using an Interpreter                         KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The nurse must tell a 94-year-old resident of a nursing home that his wife has fallen and has been hospitalized with a broken hip. What is the most effective method for the nurse to deliver the news?
a. Hurry through the conversation to spare the resident.
b. Conserve time by delaying plans for follow-up.
c. Use social conversation before the delivery of the information.
d. Gather all pertinent information that is accurate.

 

 

ANS:  D

The nurse should gather all the pertinent information to address the resident’s questions. The message should be direct and simple, and time should be allowed for the resident to react. Follow-up plans should be considered.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 98               OBJ:   4

TOP:   Delivering Bad News                      KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. What is the correct terminology for the area within 18 inches of a person?
a. Public space
b. Social space
c. Personal space
d. Intimate space

 

 

ANS:  D

The space within 18 inches of the body is considered intimate space.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 91               OBJ:   1

TOP:   Proxemics      KEY:  Nursing Process Step: N/A              MSC:  NCLEX: N/A

 

  1. What is the correct term for the area between 18 inches and 4 feet of a person?
a. Public space
b. Social space
c. Personal space
d. Intimate space

 

 

ANS:  C

A distance of 18 inches to 4 feet is considered personal space.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 91               OBJ:   1

TOP:   Proxemics      KEY:  Nursing Process Step: N/A              MSC:  NCLEX: N/A

 

  1. The area between 4 and 12 feet of a person is commonly referred to as which of the following?
a. Public space
b. Social space
c. Personal space
d. Intimate space

 

 

ANS:  B

Between 4 and 12 feet is considered social space.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 91               OBJ:   1

TOP:   Proxemics      KEY:  Nursing Process Step: N/A              MSC:  NCLEX: N/A

 

  1. The area 12 feet from a person and beyond is known as _____ space.
a. public
b. social
c. personal
d. intimate

 

 

ANS:  A

Public space is when strangers are 12 feet or more away from a person.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 91               OBJ:   1

TOP:   Proxemics      KEY:  Nursing Process Step: N/A              MSC:  NCLEX: N/A

 

MULTIPLE RESPONSE

 

  1. In what respect do Baby Boombers differ from young adults? (Select all that apply.)
a. Experience with technology
b. Attitude about lifestyles
c. Value of money
d. Methods of communication
e. Perceptions of gender roles

 

 

ANS:  B, C, D, E

Older adults today have knowledge of technology and electronic tools of communication, such as cell phones and computers.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 88               OBJ:   1

TOP:   Age Bracket Differences                  KEY:  Nursing Process Step: N/A

MSC:  NCLEX: N/A

 

  1. What is successful communication dependent on? (Select all that apply.)
a. The need to share information with someone else
b. Empathetic listening
c. Assessing or correcting communication barriers
d. Using perfect grammar
e. Use of a variety of communication skills

 

 

ANS:  A, B, C, E

Perfect grammar is not essential to successful communication.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 88               OBJ:   1

TOP:   Successful Communication              KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. What should the nurse base her communication approach on for the most effective communication? (Select all that apply.)
a. Culture
b. Ethnicity
c. Income level
d. Perspective
e. Level of education

 

 

ANS:  A, B, D, E

Income level is not a consideration in effective communication.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 94               OBJ:   1

TOP:   Communication with Older Adults   KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The nurse is sensitive to the use of nonverbal communication from patients, which includes the interpretation of __________. (Select all that apply.)
a. choice of words
b. voice tone
c. body language
d. gestures
e. facial expressions

 

 

ANS:  B, C, D, E

Choice of words indicates verbal communication. All other options play a part in nonverbal communication.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 90-93        OBJ:   3

TOP:   Nonverbal Communication              KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. What would the nurse be conveying when using touch as a form of communication? (Select all that apply.)
a. Affection
b. Understanding
c. Concern
d. Apathy
e. Acknowledgment

 

 

ANS:  A, B, C, E

The use of touch as communication coveys affection, understanding, concern, and acknowledgement.  It does not convey apathy.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 93               OBJ:   3

TOP:   Touch            KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. Which of the following examples represent “elderspeak?” (Select all that apply.)
a. “Ok, honey, let’s get a bath now.”
b. “Oh, dear! We better get you a clean diaper.”
c. “Today is Tuesday, Mr. Brown. It’s your dialysis day.”
d. “My gracious, Mary! What in the world are you doing out here in the hall?”
e. “You naughty girl! Just look at the front of your dress.”

 

 

ANS:  A, B, D, E

Using baby talk and endearing names is demeaning and is a subtle form of abuse. Giving direct information to the patient, treating the patient as an adult, and using the patient’s proper name are respectful types of dialogue.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 94               OBJ:   1

TOP:   Elderspeak     KEY:  Nursing Process Step: N/A              MSC:  NCLEX: N/A

 

  1. What are communication barriers that are encountered when conversing with an older adult? (Select all that apply.)
a. Hearing impairment
b. Language differences
c. Dementia
d. Pain
e. Decreased mobility

 

 

ANS:  A, B, C, D

Decreased mobility does not affect a person’s ability to communicate. All other options are communication barriers.

 

DIF:    Cognitive Level: Knowledge            REF:   pp. 94-95        OBJ:   1

TOP:   Language Barriers                           KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Psychosocial Integrity: Coping and Adaptation

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