Chapter 8

Question 1

Principles of communication allow nurses to adapt to which of the following trends?

a. Generation X c. Telephone technology
b. Cultural diversity d. Kinesthetic communication

Answer 1

B: Principles of communication allow nurses to adapt to trends such as increasing diversity, an aging population, and computer technology. The traditional visual, auditory, and kinesthetic modes of communication are shifting to computer technology. It is estimated that 20 percent of the population will be 65 years of age or older by 2020. These trends affect the profession of nursing and its practice. TRENDS IN SOCIETY THAT AFFECT COMMUNICATION

Question 2

When the nurse asks the client a question, the nurse is considered the:

a. sender. c. receiver.
b. message. d. feedback.

Answer 2

A: The message originates with the sender. It consists of verbal and nonverbal stimuli that are taken in by the receiver. The message is the “what” in communication. The receiver takes in the message and analyzes it. The new message that is generated by the receiver in response to the original message from the sender is the feedback. FIGURE 8-1 ELEMENTS OF THE COMMUNICATION PROCESS

Question 3

The Health Insurance Portability and Accountability Act (HIPAA) was developed to:

a. make it easier to transport and transmit your personal health information.
b. guard against insurance companies selling their client list of names and addresses.
c. protect all individuals’ identifiable health information held or transmitted.
d. make health insurance companies more accountable for payment of claims.

Answer 3

C: HIPAA was developed to protect all individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, paper, or oral.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996

Question 4

Nonverbal communication is considered:

a. conscious. c. written documents
b. unconscious. d. wireless e-mail.

Answer 4

B: Nonverbal communication tends to be unconscious and more difficult to control than verbal communication. Written documents and e-mail are both forms of verbal communication. MODES OF COMMUNICATION

Question 5

When communicating using technology such as e-mail, it is important to proofread your correspondence for appropriate use of:

a. spelling, grammar, punctuation, and accuracy.
b. inclusion of emoticons for nonverbal cues.
c. design, length of message, color, and font size.
d. notation for an acceptable response time.

Answer 5

A: The first tip in communicating using technology is to keep in mind that accurate spelling, correct grammar, and organization of thought assume greater importance in the absence of verbal and nonverbal cues that are given in face-to-face encounters. ELECTRONIC COMMUNICATION

Question 6

A staff nurse remembers an important piece of information that should have been relayed to the supervisor before the nurse left the unit. Since the message is urgent, the nurse would consider which communication tool as primary, in order to transmit the message to the supervisor?

a. Fax c. Blackberry
b. E-mail d. Telephone

Answer 6

D: The telephone remains the primary tool for communicating urgent information; however, some practitioners may be comfortable receiving urgent patient information, such as an elevated potassium level, electronically. ELECTRONIC COMMUNICATION

Question 7

The unit secretary is sending an e-mail message to all staff. Recognizing e-mail etiquette, the secretary would do which of the following?

a. Use capital letters generously for emphasis
b. Respond immediately to an angry message
c. Refrain from forwarding e-mail messages from others without their permission
d. Include a joke at the end of the e-mail so readers will be more likely to read the entire message

Answer 7

C: Tips for communicating by e-mail include the following: No capital letters, be brief, use clear subject lines, cool off before responding to an angry message, forward e-mail messages from others only with their permission, forward jokes selectively, and use good judgment because e-mail may not be private. ELECTRONIC COMMUNICATION

Question 8

When the nurse says to himself, “I can do this procedure,” it is a form of what level of communication?

a. Interpersonal c. Nonverbal
b. Intrapersonal d. Nonpublic

Answer 8

B: Intrapersonal communication can be thought of as self-talk. It is what people do within themselves, and it can present as either doubts or affirmations. Interpersonal communication is communication between individuals or small groups. A nurse presenting a workshop is an example of public communication. Nonverbal language deals with body language or facial expressions. INTRAPERSONAL COMMUNICATION

Question 9

Verbal communication relies on which of the following to convey a message?

a. Facial expression c. Gestures
b. Posture d. Speaking words

Answer 9

D: Verbal communication relies on speaking words to convey a message. Nonverbal communication consists of aspects of communication that are outside what is spoken such as appearance, facial expressions, posture, gait, body movements, position, and gestures. MODES OF COMMUNICATION

Question 10

The level of communication that is concerned with communication between individuals is:

a. interpersonal. c. public.
b. intrapersonal. d. physiological.

Answer 10

A: Interpersonal communication is concerned with communication between individuals, either person to person or in small groups. Intrapersonal communication is self-talk. Public communication is communicating with a group of people with a common interest. Kinesthetic communication involves touch and physiological responses. INTERPERSONAL COMMUNICATION

Question 11

The chief executive officer of an organization announces that the company will adopt a new policy. This organizational communication is called:

a. downward. c. lateral.
b. upward. d. diagonal.

Answer 11

A: A chief executive officer’s communication is considered downward communication. The message starts at the top and is disseminated by levels through the chain of communication. ORGANIZATIONAL COMMUNICATION

Question 12

When a nurse recommends to the nurse manager a more efficient approach to organizing care, this type of organizational communication is called:

a. downward. c. lateral.
b. upward. d. diagonal.

Answer 12

B: In upward communication, the idea originates at some level below the top of the structure and moves upward ORGANIZATIONAL COMMUNICATION

Question 13

In the world of work and service, you can create and sustain high-quality connections by all of the following except:

a. providing support. c. fostering admiration.
b. showing appreciation. d. avoiding negative people.

Answer 13

D: Avoiding negative people does not help create and sustain high-quality connections. Providing support, showing appreciation, fostering admiration, challenging, and expressing hope for the future are all ways to energize people at work and develop high-quality connections REAL WORLD INTERVIEW

Question 14

The communication skill that centers on the main point is called:

a. supporting. c. reassuring.
b. focusing. d. accepting.

Answer 14

B: The communication skill of focusing centers on the main point. Supporting is siding with another person or backing up another person. Reassuring restores confidence or removes fear. Accepting makes known that another is capable or worthy. TABLE 8-2 FOCUSING

Question 15

The statement “You are so thoughtful” is an example of which of the following communication skills?

a. Providing information c. Conveying acceptance
b. Expressing appreciation d. Conveying reassurance

Answer 15

B: The comment “You are so thoughtful,” is expressing appreciation, which shows gratitude. An example of providing information would be “It is common for people with pneumonia to be tired.” The statement “It is okay to cry” conveys acceptance. Conveying reassurance is reflected in the comment “I can assure you that tomorrow will be better.” TABLE 8-2 COMMUNICATION SKILLS

Question 16

Active listening for what is said and how it is said, as well as noting nonverbal cues that support or negate congruence, is called:

a. attending. c. clarifying.
b. responding. d. confronting.

Answer 16

A: Attending is the active listening for what is said and how it is said as well as noting nonverbal cues that support or negate congruence. Responding is verbal and nonverbal acknowledgement of the sender’s message. Clarifying is restating, questioning, and rephrasing to help the message become clear. Confronting is identifying the conflict and then clearly delineating the problem. TABLE 8-2 COMMUNICATION SKILLS

Question 17

A common barrier to communication is:

a. management styles. c. sadness and frustration.
b. different language. d. decreased face-to-face contact.

Answer 17

B: Some of the most common barriers to communication are language, gender, culture, anger, generational differences, illiteracy, and conflict. BARRIERS TO COMMUNICATION

Question 18

An individual who is seeking health care services and who has limited proficiency in English has the right to have an interpreter available to facilitate communication within the health care system. This statement is according to what legal requirement?

a. Title VI of the Civil Rights Act of 1964
b. The Joint Commission
c. U.S. Code Title XIX addressing individuals entitled to medical assistance
d. Health Information Portability and Accessibility Act

Answer 18

A: Based on Title VI of the Civil Rights Act of 1964, the individual has a right to have an interpreter available to facilitate communication within the health care system 24 hours a day, 7 days a week. Face-to-face interpretation is desirable, telephone services are permissible, and family or friend is acceptable only when the patient expresses the preference to have them. LINGUISTICALLY APPROPRIATE SERVICES

Question 19

It is important for nurses to be aware of generational differences when caring for individuals. Baby boomers are known for their:

a. paying dues and conformity.
b. being comfortable with technology.
c. defining themselves through their employment.
d. independence and changing employment places often.

Answer 19

C: Veterans believe in hard work, paying dues, and conformity. Baby Boomers define themselves through employment. Generation X’ers are independent, change employment places often, and are comfortable with technology. Generation Y’ers are optimistic, expect diversity, and are technologically savvy. GENERATIONAL DIFFERENCES – EVIDENCE FROM THE LITERATURE

Question 20

Approximately what fraction of the population in the United States is functionally illiterate?

a. One-third c. One-eight
b. One-fourth d. One-tenth

Answer 20

B: About a quarter of the adult population in the United States is functionally illiterate, and nearly half have limited literacy skills. ILLITERACY

Question 21

The communication of unfairly categorizing someone based on her traits is called:

a. false reassurance. c. stereotyping.
b. being defensive. d. interrupting.

Answer 21

C: Unfairly categorizing someone based on her traits is called stereotyping. False reassurance promises something that cannot be delivered. Being defensive is acting as if one has been attacked. Interrupting is speaking before the other person has completed a message. TABLE 8-4 ADDITIONAL BARRIERS TO COMMUNICATION

Question 22

The communication of ill-defined tasks or duties that makes successful completion unlikely is called:

a. inattention. c. unclear expectations.
b. stress. d. false reassurance.

Answer 22

C: Unclear expectations are ill-defined tasks or duties that make successful completion unlikely. Inattention is not paying attention. Stress is a state of tension that gets in the way of reasoning. False reassurance promises something that cannot be delivered. TABLE 8-4 ADDITIONAL BARRIERS TO COMMUNICATION

Question 23

Communicating with physicians need not be stressful for new nurses if they remember to:

a. work through emotions before talking with the physician.
b. keep the patient’s goal central to the discussion.
c. maintain shoulder-to-shoulder dialogue.
d. document patient changes thoroughly.

Answer 23

B: The nurse’s goal is to strive for collaboration, keeping the patient goal central to the discussion. Collaboration allows all parties to be satisfied and improves quality. NURSE PRACTITIONERS AND OTHER HEALTH CARE PROFESSIONALS

Question 24

If a nurse contacts the physician and the physician gives an inappropriate answer or gives no orders, the nurse should document this by:

a. contacting the supervisor and completing a peer review committee report.
b. completing an incident report and routing the report to the medical ethics committee.
c. completing a physician’s order and sending it to the emergency room physician to obtain orders.
d. documenting the call in the chart, the information relayed, and the fact that no orders were given.

Answer 24

D: If the physician gives an inappropriate answer or gives no orders, document the call, the information relayed, and the fact that no orders were given. Peer review pertains to nursing. Completing an incident report would be appropriate only if the physician hangs up or terminates the call. Completing a physician’s order is illegal without the physician’s dictation of orders to the nurse. NURSE PRACTITIONERS AND OTHER HEALTH CARE PROFESSIONALS

Question 25

The SBAR technique (situation-background-assessment-recommendation) is designed to improve communication among health care personnel. Which of the following is an example of assessment?

a. “I’m calling about Mr. Jones in 312.”
b. “Mr. Jones hasn’t had a bowel movement in 2 days, which is unusual for him.”
c. “Mr. Jones has decreased peristalsis, abdominal discomfort, and is on a narcotic analgesic.”
d. “Can we start him on Colace 2 BID and add magnesium citrate if no BM within 8 hours?”

Answer 25

C: The assessment is decreased peristalsis, abdominal discomfort, and narcotic analgesic use, which details the patient’s condition for the physician. “Mr. Jones hasn’t had a bowel movement in 2 days, which is unusual for him,” is background information. “Can we start him on Colace?” is the recommendation. “I’m calling about Mr. Jones in 312” is giving the physician the identity of the patient you are calling about and setting the situation. TABLE 8-8 SBAR TOOL TO ORGANIZE INFORMATION FOR CALLING ANOTHER NURSING OR MEDICAL PRACTITIONER FOR ASSISTANCE

Question 26

A culturally sensitive nurse can use which of the following techniques when communicating with colleagues of different cultures?

a. Use only written communication channels.
b. Minimize the use of jargon specific to the nurse’s culture.
c. State “I’m trying to get through to you, don’t you understand.”
d. Continue to listen even when the nurse doesn’t understand the message.

Answer 26

B: The culturally sensitive nurse would eliminate the use of jargon specific to the nurse’s culture when communicating with a colleague of a different culture. Both written and oral communication are appropriate. Stating “I’m trying to get through to you, don’t you understand?” is condescending. The nurse should seek clarification when a message is not understood. TABLE 8-5 OVERCOMING COMMUNICATION BARRIERS

Question 27

The charge nurse is working with staff members who consist of nurses in their 20s and are considered to be part of Generation Y. The charge nurse recognizes that this generation has which of the following characteristics?

a. They are willing to work long hours and define themselves through employment.
b. They tend to be optimistic, street smart, expect diversity, crave structure, and are technologically savvy.
c. They believe in hard work, paying dues, conformity, and long-term commitment.
d. They are independent, comfortable with technology, and seek connection with managers on equal footing.

Answer 27

B: The charge nurse would recognize that Generation Y nurses tend to be optimistic, street smart, expect diversity, crave structure, and are technologically savvy. Option a describes Baby Boomers, option c describes individuals known as Matures/Veterans. Option d describes Generation X. GENERATIONAL DIFFERENCES

Question 28

A nurse is preparing for retirement. Because the nurse has always believed that his self-worth = work, the nurse has begun the process of anticipatory grief over the upcoming loss. The nurse is most likely in which generational group?

a. Baby Boomer c. Generation Y
b. Generation X d. Generation Z

Answer 28

A: The nurse is most likely a member of the Baby Boomer generation. These individuals define themselves through employment and tend to believe that self-worth = work. EVIDENCE FROM THE LITERATURE

Question 29

Due to your mother’s illness, you have been absent from work for 2 weeks. After receiving a nasty e-mail from your supervisor, you find yourself becoming extremely angry. What should you do before responding to the supervisor’s insensitive e-mail?

a. Ignore the message
b. Cool off before responding to the message
c. Respond immediately to the e-mail and attach a letter of resignation
d. Find a lawyer to sue the supervisor for harassment

Answer 29

B: You should not respond to the e-mail while you are angry. First, you should cool off and consider responding the next day when you are not as upset. ELECTRONIC COMMUNICATION

Question 30

An LPN tells the team leader that she is interested in returning to school but she has to first plan how she will obtain the needed tuition. The supervisor tells the LPN, “Just get a loan, everybody is doing that!” The supervisor’s comment is an example of which barrier to communication?

a. Supporting c. Unclear expectations
b. Focusing d. Giving advice

Answer 30

D: The supervisor has blocked communication by giving the LPN the advice to get a loan. Giving advice assumes the other person is unable to solve her own problems. TABLE 8-4 ADDITIONAL BARRIERS TO COMMUNICATION