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Chapter 05: The Nurse-Patient Relationship
Linton: Introduction to Medical-Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1.A nurse is preparing an anxious patient for major surgery and remarks, “Everyone feels some anxiety, but you will be asleep during the whole thing.” Which communication style does this exemplify?
| a. | Empathy |
| b. | Summarizing |
| c. | False reassurance |
| d. | Premature advice |
ANS: C
False reassurance shows lack of effort to understand and shuts off communication by imposing personal opinion. It may sound empathetic, but false reassurance does not encourage further communication.
DIF: Cognitive Level: Comprehension REF: p. 63 OBJ: 8
TOP: Communication Techniques KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
2.A nurse is explaining a pamphlet called the “Patient Care Partnership” to a patient and family. Who should the nurse indicate created this pamphlet?
| a. | The Joint Commission |
| b. | Medicare/Medicaid Act |
| c. | Social Security Act |
| d. | American Hospital Association |
ANS: D
When displayed prominently in care areas, the “Patient Care Partnership” gives the patient, family, and caregivers a written reminder of the rights of the competent patient for his or her own care decisions and was created by the American Hospital Association.
DIF: Cognitive Level: Knowledge REF: p. 59 OBJ: 5
TOP: Patient’s Bill of Rights KEY: Nursing Process Step: Implementation
MSC:NCLEX: Safe, Effective Care Environment: Coordinated Care
3.A nurse is discussing the discharge plan with a recovering patient. What is the most effective communication technique for this nurse to implement?
| a. | Assess nonverbal clues. |
| b. | Allow communication to focus on whatever topic the patient desires. |
| c. | Insist on postrecovery activities as stated in the care plan. |
| d. | Reduce eye contact to convey nondirective attitudes. |
ANS: A
The assessment of the nonverbal clues will allow the nurse to determine whether the care plan is being perceived as satisfactory and will indicate the level of compliance that can be expected. Allowing the patient to control the interview does not meet nursing care needs. Lack of eye contact and forcing the components of the discharge plan on a patient are both counterproductive.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 8
TOP: Communication Techniques KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
4.A 6-year-old child is brought to the Public Health Clinic Building to receive immunizations for the beginning of school. What is the proper classification for the recipient of this service?
| a. | Patient |
| b. | Child |
| c. | Customer |
| d. | Client |
ANS: D
The term client, in the modern context, refers to one who is not ill and who is a partner in maintaining wellness.
DIF: Cognitive Level: Comprehension REF: p. 59 OBJ: 4
TOP: Patient Image KEY: Nursing Process Step: N/A
MSC:NCLEX: N/A
5.A patient says, “I am sick of being sick.” What is the most therapeutic response?
| a. | “I can’t believe you really feel that way.” |
| b. | “I don’t think that attitude is very helpful.” |
| c. | “I think you sound pretty frustrated.” |
| d. | “I want you to feel more positive.” |
ANS: C
“I” statements are used to confirm that the nurse understands the message from the patient.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 8
TOP: “I” Statements KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
6.On returning to the nurse’s station, a licensed practical/vocational nurse (LPN/LVN) discovers that the daughter of a frail but competent resident is reading her mother’s chart. The woman says, “I am entitled to see my mother’s medical record.” What is the nurse’s best response?
| a. | “What is it that you believe you need to know? Give me the chart.” |
| b. | “You must understand that only your mother has the right to read the contents of her medical record. Please give me the chart.” |
| c. | “Although the chart itself is not available to you to read, I would be glad to try to answer any questions you have. May I have the chart, please?” |
| d. | “Reading that chart is a very serious violation of your mother’s privacy. I cannot allow you to see it. Please put down the chart.” |
ANS: C
Unless the patient is legally declared incompetent and the person requesting to discuss the chart information is appointed a legal surrogate, the patient has the right to privacy and confidentiality. All of the other options are demanding or aggressive, invite a power struggle, and do not fulfill the daughter’s need for information.
DIF: Cognitive Level: Application REF: p. 59 OBJ: 8
TOP:Patient’s Right to Privacy and Confidentiality
KEY:Nursing Process Step: Implementation
MSC:NCLEX: Safe, Effective Care Environment: Coordinated Care
7.A PN/VN student is assigned to a patient who makes homosexual remarks and asks the student to meet after discharge. What is the student’s best response?
| a. | “I am required to report inappropriate sexual behavior to my instructor.” |
| b. | “I am uncomfortable dealing with homosexuals. Let’s just forget this conversation and get on with your care as quickly as possible.” |
| c. | “I am here as your nurse to meet your treatment needs. Such provocative conversation is not acceptable to me as part of your care.” |
| d. | “Your chosen lifestyle makes me uncomfortable. I will be back with your medication.” |
ANS: C
The patient has a right to have the nurses behave respectfully, regardless of sexual orientation. Setting limits without belittling the patient is a professional response. The nurse should be open, honest, and nonjudgmental.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 8
TOP:Therapeutic Communication and Respectful Care
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
8.A patient with newly diagnosed cancer states, “I can’t stand to think about chemo.” What is the most therapeutic response?
| a. | “What about chemo concerns you?” |
| b. | “Chemo is so much better than it used to be.” |
| c. | “Wow! I can sure understand that!” |
| d. | “Have you had chemo before?” |
ANS: A
The open-ended query invites further discussion about the patient’s concerns. The other options reinforce the patient’s concerns, give false reassurance, or offer a closed query.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 8
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
9.The families of patients expect their hospitalized member to receive holistic care. What characteristic is an example of provision of holistic care?
| a. | Providing safety with the side rails up |
| b. | Providing only foods and drinks that are to the patient’s liking |
| c. | Bathing at a time and manner that is specified by the patient |
| d. | Including the family in the holistic approach |
ANS: D
The practice of holistic care of patients includes the family, as well as the patient, in meeting physical, emotional, social, economic, and spiritual needs.
DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: 1
TOP:Family Expectations and Holistic Care
KEY:Nursing Process Step: Implementation
MSC:NCLEX: Safe, Effective Care Environment: Coordinated Care
10.A nurse, as a unique person, brings to each practice-patient relationship qualities such as knowledge, experiences, strengths, and weaknesses. What is the inclusive term used to describe this phenomenon?
| a. | Personhood experiences |
| b. | Physiologic influence |
| c. | Sociologic influence |
| d. | Use of self in nursing |
ANS: D
The nurse brings all parts of personality into the care setting.
DIF: Cognitive Level: Knowledge REF: p. 57 OBJ: 2 | 3
TOP: Use of Self in Nursing KEY: Nursing Process Step: N/A
MSC:NCLEX: N/A
11.A patient asks the nurse who is picking up the breakfast trays, “What will happen during the radiology test this morning?” The nurse replies, “All the necessary explanations are on that sheet of paper on the table.” What does this response violate?
| a. | Confidentiality |
| b. | Privacy |
| c. | Explanation of care |
| d. | Continuity of care |
ANS: C
All patients have the right to an explanation of all aspects of care and treatment.
DIF: Cognitive Level: Comprehension REF: p. 60 OBJ: 7
TOP: Explanation of Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
12.A dying patient says, “There is no God. There is no afterlife. When it’s over, it’s over.” What is the most therapeutic response?
| a. | “You must feel very lonely.” |
| b. | “Of course there is a God, and He loves you very much.” |
| c. | “Why do you think there is no God?” |
| d. | “You are absolutely right. I think that, too.” |
ANS: A
Verbalizing the implied helps the patient talk about present concerns. Other options either reinforce or cut off communication by imposing the nurse’s beliefs.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 8
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
13.A newly admitted 80-year-old patient with hemiplegia is fully alert. Which is the most appropriate greeting by the nurse?
| a. | “Good morning, Mrs. Brown. My name is Ann, and I am your nurse today.” |
| b. | “I am your nurse. Today is bath day. You will get yours right after breakfast.” |
| c. | “Hello there, sweetie. We need to get to work on getting your breakfast so we can get your shower.” |
| d. | “My name is Ann. You are my patient today.” |
ANS: A
Older persons who are new to a unit need to be addressed by name. Introductions of caregivers should be made without familiarity.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 4 | 8
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
14.Sometimes patients communicate by crying, moaning, or laughing. What should this behavior be considered?
| a. | Verbal communication |
| b. | Nonverbal communication |
| c. | Acting out and seeking attention |
| d. | Seeking holistic support |
ANS: B
Emotions are frequently expressed through nonverbal methods.
DIF: Cognitive Level: Comprehension REF: p. 61 OBJ: 8
TOP: Recognition of Nonverbal Clues KEY: Nursing Process Step: N/A
MSC:NCLEX: N/A
15.A nurse communicates in an open, honest, and nonjudgmental manner. How should this approach be characterized?
| a. | Therapeutic communication |
| b. | Democratic communication |
| c. | “I” statements |
| d. | Autocratic communication |
ANS: A
Therapeutic communication implies an open and honest verbal and nonverbal style of communication.
DIF: Cognitive Level: Comprehension REF: p. 62 OBJ: 8
TOP:Qualities of Therapeutic Communication
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coping and Adaptation
16.An LPN/LVN finds a young man tearfully staring out the window. He says, “I’ve been in this hospital 23 days out of the last 50. I’ve lost a lot of pay.” What response by the nurse should be used to encourage further communication?
| a. | “You’ve lost a lot of work?” |
| b. | “Would you like me to arrange an appointment for you to speak with the social worker?” |
| c. | “How much pay have you lost?” |
| d. | “You are to be discharged at the end of the week, and you can return to work.” |
ANS: A
The reflective response encourages the patient to continue. Arranging for a social worker, pointing out his return to work, and inquiry related to lost wages close communication without responding to the patient’s needs.
DIF: Cognitive Level: Application REF: p. 64 OBJ: 3 | 8
TOP: Use of Self with Empathy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
17.A nurse is careful to perform each procedure in the same step-by-step manner. What will this consistency of care accomplish?
| a. | That no step is omitted |
| b. | Complete safety |
| c. | Confidence in the nurse’s competence |
| d. | Save time |
ANS: C
One of the expectations of hospitalization is to receive competent care. Precise step-by-step procedures build patient confidence that the nurse is competent.
DIF: Cognitive Level: Comprehension REF: p. 60 OBJ: 6
TOP:Expectations for Hospitalization Care
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
18.A nurse is assigned to a patient who has been a very close family friend for many years. What statement would be most appropriate for the nurse to maintain a therapeutic relationship under these circumstances?
| a. | “Don’t worry about a thing. I will see that extra care is given to you on the other shifts, because you are my friend.” |
| b. | “You may feel uncomfortable about my caring for you. Although everything that happens here is considered to be confidential, would you prefer another caregiver?” |
| c. | “This is a very busy unit, but I will make sure that you get lots of attention, and I will come back after my shift to help you.” |
| d. | “I’m so sorry that you are hospitalized, but I will tell all my friends to take special care of you for me.” |
ANS: B
Even friends as patients should retain decision-making options about their care.
DIF: Cognitive Level: Application REF: p. 61 OBJ: 7
TOP: Professional Caring for a Friend KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
19.A nurse is changing an abdominal dressing on a disoriented 89-year-old man when he grabs the nurse’s breast muttering something about “Mary” (his wife). What is the most therapeutic response by the nurse?
| a. | Stereotype him as a “dirty old man” and warn the rest of the staff to stay away from him. |
| b. | Get a physician’s order for wrist restraints when nurses go near the patient for activities such as dressings, baths, and feedings. |
| c. | Maintain eye contact with the patient and then clearly tell him and repeat, “I am your nurse. I am coming to help you eat, bathe, and change your stomach bandage. I am not Mary.” |
| d. | “That dressing needs changing. Don’t be a naughty boy with me again or I will slap your hands and call Mary to come and do all your care herself!” |
ANS: C
Older, confused patients frequently confuse the nurse with close relations such as a spouse, whom they are accustomed to touching. Nurses should provide understanding and maintain a therapeutic environment.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 7 | 8
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
20.A young woman comes to the public health clinic for an antibiotic to treat a sexually transmitted infection (STI). She is accompanied by her live-in boyfriend. What is the most therapeutic remark by the nurse?
| a. | “Her infection is very contagious. Would you like me to give you the name of a place where you can be screened for the infection and be given the means for a cure?” |
| b. | “You probably have the same sexual infection. You need to see about it before you give it back to her or somebody else.” |
| c. | “You may have the same infection. Have you been with any other women lately? The health department needs to make a list.” |
| d. | “This is the third time that your friend has been in here with the same infection! Why don’t you get some shots yourself?” |
ANS: A
Therapeutic communication carefully chooses descriptive words that are nonjudgmental and fitting to the sociocultural background of the patient.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 7 | 8
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
21.What is a nurse trying to discern when assessing a patient’s affect?
| a. | Problem |
| b. | Mood |
| c. | Orientation |
| d. | Needs |
ANS: B
A patient’s affect is the patient’s mood.
DIF: Cognitive Level: Comprehension REF: p. 62 OBJ: 7
TOP: Nurse-Patient Relationship KEY: Nursing Process Step: N/A
MSC:NCLEX: N/A
22.A newly admitted resident to a long-term care facility tells the nurse that he misses his dog. What is the most therapeutic response by the nurse?
| a. | “You need to get a stuffed dog to keep you company.” |
| b. | “Have you made friends with Buddy, our facility’s mascot?” |
| c. | “Yes, dogs are a great deal of company.” |
| d. | “What do you miss about your dog?” |
ANS: D
Open-ended responses encourage discussion. Options that give premature advice or block communication are not therapeutic.
DIF: Cognitive Level: Application REF: p. 63 OBJ: 8
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
MULTIPLE RESPONSE
23.What does the pamphlet “Patient Care Partnership” clarify that patients will have? (Select all that apply.)
| a. | Provision of respectful care |
| b. | Protection of privacy |
| c. | Access to medical records |
| d. | Reasonable fees for service |
| e. | Information concerning current condition |
ANS: A, B, C, E
The pamphlet provides for all the options except reasonable fees.
DIF: Cognitive Level: Comprehension REF: p. 59-60 OBJ: 5
TOP: Patient’s Bill of Rights KEY: Nursing Process Step: Implementation
MSC:NCLEX: Safe, Effective Care Environment: Coordinated Care
24.What aspects should be included in a plan of care in modern holistic nursing? (Select all that apply.)
| a. | Psychologic |
| b. | Financial |
| c. | Physiologic |
| d. | Spiritual |
| e. | Sociologic |
ANS: A, C, D, E
Holism embraces the physiologic, psychologic, sociologic, and spiritual aspects of care. Financial concerns are included in the sociologic aspect.
DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: 1
TOP: Holistic Nursing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
25.A nurse is diligent in keeping a patient informed about treatments, medication, and laboratory tests. What should the provision of this information accomplish for the patient? (Select all that apply.)
| a. | Less anxiety |
| b. | More participation in care |
| c. | Less likelihood of complaints |
| d. | More compliance with treatment goals |
| e. | More satisfaction with treatment outcomes |
ANS: A, B, D, E
An informed patient will experience less anxiety and satisfaction with outcomes in which he or she has had a part. However, such participation and information does not ensure fewer complaints.
DIF: Cognitive Level: Comprehension REF: p. 60 OBJ: 5 | 7
TOP: Partners in Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
26.How does a therapeutic relationship differ from a social relationship? (Select all that apply.)
| a. | Has no limits |
| b. | Is always acceptable to the patient |
| c. | Is goal directed |
| d. | Is nonjudgmental |
| e. | Focuses only on the patient |
ANS: C, D, E
The therapeutic relationship is goal directed and nonjudgmental and focuses only on the patient. The therapeutic relationship does have limits that may be placed on both the patient and the nurse. The therapeutic relationship is sometimes difficult for a patient to accept.
DIF: Cognitive Level: Comprehension REF: p. 61 OBJ: 7
TOP: Therapeutic Relationships KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
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