CHAPTER 24 COMMUNICATION

A nurse is assigned to care for a patient for the first time and states, “I don’t know a lot about your culture and want to learn how to better meet your health care needs.” Which therapeutic communication technique did the nurse use in this situation?

Humility

CHAPTER 24 COMMUNICATION

A new nurse is experiencing lateral violence at work. Which steps could the nurse take to address this problem?

Talk with the preceptor or manager and ask for assistance in handling this issue

CHAPTER 24 COMMUNICATION

A nurse has been gathering physical assessment data on a patient and is now listening to the patient’s concerns. The nurse sets a goal of care that incorporates the patient’s desire to make treatment decisions. This is an example of the nurse engaged in which phase of the nurse-patient relationship?

Working phase

CHAPTER 24 COMMUNICATION

A patient is evaluated in the emergency department after causing an automobile accident while being under the influence of alcohol. While assessing the patient, which statement would be the most therapeutic?

“Tell me what happened before, during, and after the automobile accident tonight.”

CHAPTER 24 COMMUNICATION

A nursing student is reviewing a process recording with the instructor. The student engaged the patient in a discussion about availability of family members to provide support at home once the patient is discharged. The student reviews with the instructor whether the comments used encouraged openness and allowed the patient to “tell his story.” This is an example of which step of the nursing process?

Evaluation

CHAPTER 24 COMMUNICATION

When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.)

• Check for needed adaptive equipment.
• Give the patient time to respond to questions.
• Keep communication short and to the point.

CHAPTER 24 COMMUNICATION

Nurses must communicate effectively with the health care team for which of the following reasons? (Select all that apply.)

• Reduce the risk of errors to the patient
• Provide optimum level of patient care
• Improve patient outcomes

CHAPTER 24 COMMUNICATION

Motivational interviewing (MI) is a technique that applies understanding a patient’s values and goals in helping the patient make behavior changes. What are other benefits of using MI techniques? (Select all that apply.)

• Gaining an understanding of patient’s motivations
• Recognizing patient’s strengths and supporting their efforts
• Identifying differences in patient’s health goals and current behaviors

CHAPTER 24 COMMUNICATION

Which strategies should a nurse use to facilitate a safe transition of care during a patient’s transfer from the hospital to a skilled nursing facility? (Select all that apply.)

• Collaboration between staff members from sending and receiving departments
• Using a standardized transfer policy and transfer tool

CHAPTER 24 COMMUNICATION

The nurse uses silence as a therapeutic communication technique. What is the purpose of the nurse’s silence? (Select all that apply.)

• Prompt the patient to talk when he or she is ready
• Allow the patient time to think and gain insight

The nurse summarizes the conversation with the patient to determine if the patient has understood him or her. This is what element of the communication process?

Feedback

Mrs. Jones states that she gets anxious when she thinks about giving herself insulin. How do you use your understanding of intrapersonal communication to help with this?

Coach her to give herself positive messages about her ability to do this

*Intrapersonal: communication that occurs within an individual, also called self-talk, self-verbalization, or inner-thought.

The nurse has a patient who is short of breath and calls the health care provider using SBAR (Situation-Background-Assessment-Recommendation) to help with the communication. What does the nurse first address?

The patient is short of breath

*Situation: get straight to the root of the patients problem.

A patient is now in the recovery room after having vaginal surgery. Due to the positioning of the procedure, you would want to assess for what while the patient is in recovery?

• Homan's Sign
• Bowel Sounds
• Dysrhytmia
• Hemoglobin Level

Homan's Sign

Vaginal surgeries require the patient to be in the lithotomy position. This position can put the patient at risk for a deep vein thrombosis. Therefore, the nurse would want to check for this by using Homan's Sign.

After surgery your patient is semicomatose with vital signs within normal limits. As the nurse, what position would be best for this patient?

• Side positioning preferably on the left side
• Semi-Fowlers
• Prone
• Low-Fowlers

Side positioning preferably on the left side

A patient who are semicomatose are at risk for aspiration (due to secretions pooling in the mouth or vomiting which is a common side effect of sedation). Placing the patient onto their side preferably the left will help decrease the risk of aspiration and help promote cardiovascular circulation.

After surgery your patient starts to shiver uncontrollably. What nursing intervention would you do FIRST?

• Apply warm blankets & continue oxygen as prescribed
• Take the patient's rectal temperature
• Page the doctor for further orders
• Adjust the thermostat in the room

Apply warm blankets & continue oxygen as prescribed

Shivering is an early sign that the patient is starting to experience hypothermia. Immediately, the nurse would need to control the shivering by applying warm blankets and continue oxygen. When the patient starts to experience hypothermia, vital organs are not receiving as much oxygenated blood due to the vasoconstriction. Therefore, oxygen would need to be continued. Then the nurse would take the patient's temperature.

The nurse is monitoring the patient who is 24 hours post-opt from surgery. Which finding requires intervention?

• 24 hour urine output of 300 ml
• BP 100/80
• Pain rating of 4 on 1-10 scale
• Temperature of 99.3' F

24 hour urine output of 300 ml

*300 ml/24 hr = 12.5 ml/hr

*Should be 30 ml x 24 hr = 720 ml

*OR 720 ml/24 hr = 30 ml/hr

The nurse needs to watch the patient's urinary output closely. Urinary output within a 24 hour period should be at least 30 ml/hr. In this case, the patient is only urinating 12.5 ml/hr.

A patient is 6 days post-opt from abdominal surgery. The patient is to be discharged later today. The patient uses the call light and asks you to come to his room and look at his surgical site. On arrival, you see that approximately 2 inches of internal organs are protruding through the incision. What intervention would you NOT do?

• Put the patient in prone position with knees extended to put pressure on the site
• Cover the wound with sterile normal saline dressing
• Monitor for signs of shock
• Notify the MD and administer as prescribed antiemetic to prevent vomiting

Put the patient in prone position with knees extended to put pressure on the site

The patient is experiencing wound evisceration. This is an emergent situation. The patient should be placed in low Fowler's position with the knees bent to prevent abdominal tension.

A patient reports he hasn't had a bowel movement or passed gas since surgery. On assessment, you note the abdomen is distended and no bowel sounds are noted in the four quadrants. You notify the MD. What non-invasive nursing interventions can you perform without a MD order?

• Encourage ambulation, maintain NPO status, and monitor intake & output
• Insert a nasogastric attached to intermittent suction
• Administer IV fluids
• Encourage at least 3000 ml of fluids per day

Encourage ambulation, maintain NPO status, and monitor intake & output

This patient is most likely experiencing a paralytic ileus which is failure for the bowels to move its contents. The only correct non-invasive option is to encourage ambulation, maintain NPO status, and monitor intake & output. Inserting a NG tube or administering IV fluids is invasive and requires a MD order. Patients with potential paralytic ileus are to be NPO (nothing by mouth) so encouraging fluid intake is incorrect.

What is a potential postoperative concern regarding a patient who has already resumed a solid diet?

• Failure to pass stool within 12 hours of eating solid foods
• Failure to pass stool within 48 hours of eating solid foods
• Passage of excessive flatus
• Patient reports a decreased appetite

Failure to pass stool within 48 hours of eating solid foods

After a patient resumes solid food, they should have a bowel movement within 48 hours. The patient may be experiencing constipation and appropriate interventions must be followed.

A nurse is developing a care plan for a patient who is at risk for developing pneumonia after surgery. Which of the following is not an appropriate nursing intervention?

• Encourage patient intake of 3000 ml/day of fluids if not contraindicated
• Encourage patient to use the incentive spirometer device every 1-2 hours while awake
• Encourage early ambulation and patient to eat meals in beside chair
• Repositioning every 3-4 hours

Repositioning every 3-4 hours

All options are correct expect for repositioning every 3-4 hours. If the patient is unable to reposition themselves or ambulate, they must be repositioned every 1 to 2 hours minimally.

When assessing your patient who is post-opt, you notice that the patient's right calf vein feels hard, cordlike, and is tender to the touch. The patient reports it is aching and painful. What would be an inappropriate nursing intervention for this patient?

• Allow the patient to dangle the legs to help increase circulation and alleviate pain
• Instruct the patient to not sit in one position for a long period of time
• Elevate the extremity 30 degrees without allowing any pressure on affected area
• Administer anticoagulants as ordered by MD

Allow the patient to dangle the legs to help increase circulation and alleviate pain

All options are correct expect for Allow the patient to dangle the legs to help increase circulation and alleviate pain. The patient should NOT dangle the legs because this causes blood to pool in the lower extremities which will put the patient at risk for another blood clot formation.

A patient is recovering from surgery. The patient is very restless, heart rate is 120 bpm and blood pressure is 70/53, skin is cool/clammy. As the nurse you would?*

• Continue to monitor the patient
• Obtain an EKG
• Check the patient's blood glucose
• Notify the MD

Notify the MD

This is an emergency situation. The patient is more than likely experiencing a hemorrhage of some type. Notifying the MD would be the first line of action and then you could check the patient's blood glucose and obtain an EKG. This patient is probably going to need a surgical intervention.

A patient is taking Aspirin 325 mg PO by mouth daily. The patient is scheduled for surgery in a week. What education do you provide the patient with before surgery?*

• To hold his morning dose of Aspirin because the nurse will give it to him before surgery
• None of the above are correct
• The medication should be discontinued for 48 hours prior to the scheduled surgery date
• Educate the patient to take the scheduled dose of Aspirin the day of surgery to help prevent blood clots

The medication should be discontinued for 48 hours prior to the scheduled surgery date

Aspirin alters the normal clotting factors and increases the patient's chances of hemorrhaging. Therefore, it should be held for at least 48 hours prior to surgery as specified by the surgeon.

You are observing your patient use the incentive spirometry. What demonstration by the patient lets you know the patient understands how to use the device properly?*

• The patient rapidly inhales on the devices and exhales
• The patient uses the incentive spirometry once a day
• The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level
• The patient blows on the mouthpiece rapidly.

The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level

All of the options are wrong expect for "The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level". The other options do not demonstrate how to properly use the incentive spirometry.

As the nurse you are getting the patient ready for surgery. You are completing the preoperative checklist. Which of the following is not part of the preoperative checklist?*

• Informed consent is signed
• Assess for allergies
• Conducting the Time Out
• Ensuring that the history and physical examination has been completed

Conducting the Time Out

The time out is conducted by the OR nurse prior to surgery. All of the other options are conducted by the nurse getting the patient ready for surgery.

You are completing the history on a patient who is scheduled to have surgery. What health history increases the risk for surgery for the patient?*

• History of Premature Ventricle Beats
• Abuse of street drugs
• Urinary Tract infections
• Hyperthyroidism

Abuse of street drugs

If a patient has a history of street drug abuse this puts them at risk in surgery. This information is very important for the anesthesiologist due to the complications that can arise from the anestheisa. All of the other options are important to note but not a risk for surgery.

As a nurse, which statement is incorrect regarding an informed consent signed by a patient?*

• Patients under 18 years of age may need a parent or legal guardian to sign a consent form
• The nurse is responsible for obtaining the consent for surgery
• The nurse can witness the client signing the consent form
• It is the nurse's responsibility to ensure the patient has been educated by the physician about the procedure before informed consent is obtained

The nurse is responsible for obtaining the consent for surgery

It's the physicians responsibility to make sure that ALL consent forms have been signed by the patient or the patient's legal guardian, if under 18 yrs of age, BEFORE performing surgery.