Exam # 1 (321)

Question 1

Communication and Nursing Practice

Answer 1

*The foundation for professional and therapeutic relationships.
•Essential part of delivering high-quality client care.
•A skill and a life-long learning process

Question 2

Therapeutic communication

Answer 2

• Occurs within a nurse-client relationship.
  •Goal-directed
  •Descriptive and non-judgmental
  • Defined rules and boundaries
  • Client-focused
  • Personalized to the client’s needs

Question 3

Codes that convey specific meaning through a continuations of words.
The important aspects are:
Vocabulary
Denotative and connoctative meaning
Pacing
Intonation
Clarity and brevity
Timing and relevance

Answer 3

Verbal communication

Question 4

It includes five senses and everything that does not include spoken or writing words
*Personal appearance
*Posture and gait
*facial expression
*eye contact
*gestures
*sounds
*territorial and personal space

Answer 4

Non verbal communication

Question 5

The Nurse-Client Relationship

Answer 5

*Caring, therapeutic relationships are the foundation of nursing practice.
•Within these relationships, the nurse is a professional who cares about the client and their needs.
•Nursing therapeutic relationships promote positive change and growth related to health outcomes.

Question 6

*A professional relationship
•Occurs anywhere there is nursing care
•Based on ability to focus on the client’s needs
•Critical to problem resolution
•Key part of health promotion
•Sensitive to goals/values of client

Answer 6

The Therapeutic Relationship

Question 7

Professional relationship
•Explicit time frame
•Goal-oriented
•Nurse establishes, directs, and takes responsibility for the interactions
•Client needs take priority
•Purposeful communication
•Rapport
•Trust
•Empathy
•Non-judgmental
•Ethical
•Confidentiality

Answer 7

Characteristic of theraupetic relationship

Question 8

Phases of the Nurse-Client Therapeutic Relationship

Answer 8

1)Pre-interaction phase
•Before meeting a client
2)Orientation phase
•When you and the client meet and start getting to know each other
3)Working phase
•You and the client work together to solve problems and accomplish goals
4)Termination phase
•During the ending of the relationship

Question 9

Elements of Communication

Answer 9

*Messages are conveyed verbally or nonverbally.
•People communicate through words, movements, voice inflection, facial expression, and use of space.
•Combined, these elements can work to help or hurt the communication of your message

Question 10

Why is Good Communication so Important?

Answer 10

*Good communication skills reduce risk of errors .
•Promotes improved outcomes
•Competent communication meets legal, ethical, and clinical standards of care for professional nursing practice.
•Nurse behaviors and communication influence client behaviors.

Question 11

Elements of Effective Therapeutic Communication

Answer 11

•Ongoing and continuously changing
•Self-awareness
•Openness
•Self-confidence
•Genuineness
•Respect and concern for individual
•Knowledge
•Ability to empathize
•Sensitivity
•Acceptance

Question 12

Motivational Interviewing

Answer 12

*Person-centered communication approach to foster behavioral changes
•Encourages individuals to share thoughts, beliefs, fears, and concerns
•Interviewing is nonjudgmental
•Nurse needs to know what resistance or ambivalence individual has
•Nurse then focuses on strengths of individual and supports them

Question 13

Nurse-Health Care Team Relationships

Answer 13

Patient safety requires effective
communication among members of the
healthcare team

• Breakdown in communication among
healthcare workers is a major cause of
errors in the workplace

•Standardized communication tools
•SBAR

Question 14

Social, informational, and therapeutic interactions build morale, accomplish goals, and strengthen working relationships.
•Lateral violence is an issue that negatively affects the work environment
•A form of bullying
•Lateral violence can lead to:
•Job dissatisfaction
•Decreased sense of value
•Poor teamwork
•Poor retention of qualified staff
•Nurses leaving the profession

Answer 14

Nurse- nurse relationship

Question 15

Elements of Professional Communication

Answer 15

Courtesy
•Use of names
•Trustworthiness
•Autonomy
•Assertiveness
•Advocacy
•Professional boundaries

Question 16

Effective professional communication steps:

Answer 16

Firmly stating case
•Need congruent content
•Clarifying the message
•Need complete message (e.g., “I” statements)
•Seeking feedback
•Provides validation and confirmation of communication
•Being receptive to received feedback
•Facilitates functional communication

Question 17

Factors Influencing the Communication Process

Answer 17

Developmental level
•Values & perceptions
• Personal space
• Territoriality
• Roles & relationships
• Environment
• Congruence
• Interpersonal attitudes

Question 18

Therapeutic communication techniques

Answer 18

Active listening
•Sharing observations
•Sharing empathy
•Sharing hope
•Sharing humor
•Sharing feelings
•Using touch
•Using silence
•Providing information
•Clarifying
•Open-ended questions
•Focusing
•Paraphrasing
•Validation
•Asking relevant questions
•Summarizing

Question 19

Active Listening

Answer 19

Brief verbal statements that indicate interest,
“Please go on”, “Tell me more about that”
•Non-verbal behaviors
•Nodding head, posture, facial expression
•Poor Listening Behaviors
•Reacting to appearance rather than what is said
•Faking attention
•Failing to eliminate noise
•Thinking rather than listening

Question 20

The importance of “I” statements

Answer 20

Takes responsibility
• Avoids putting people on the defensive
• Makes OUR needs, thoughts, and
feelings known clearly and directly
• Avoids playing games
• Allows direct communication

“I feel__________when you_______.”

Question 21

Examples Of “I” Statements

Answer 21

Blaming:
“You can’t keep coming home so late! It’s so
inconsiderate.”
“I” Statement:
“I feel worried when you come home late. I
can’t even sleep.”
Blaming:
“You never call me. I guess we just won’t
talk anymore.”
“I” Statement:
“I feel hurt when you go so
long without calling. I’m afraid you don’t care.”

Question 22

Using open ended questions

Answer 22

*Asking broad questions that lead or invite the client to explore thoughts and feelings.
•Open-ended questions specify the topic to be discussed.
• Invites answers that are longer than one or two words

Question 23

• “Tell me about …”
• “Go on….”
• “I’d like to discuss what you’re
thinking…”
• “What are your thoughts….?”
• “What are you feeling?”

Answer 23

Open ended question prompts

Question 24

Humor

Answer 24

Coping strategy that can reduce anxiety and promote positive feelings
•Can humanize the illness experience
•Can enhance teamwork and relieve tension
•MUST be used with tact and sensitivity
•Humor has a cultural context
•Important to be sensitive to the patient
•May need to set boundaries

Question 25

Touch

Answer 25

Therapeutic touch can bring a sense of caring and human connection to an interaction with a client.
•Feelings and beliefs about touch can vary considerably among individuals, families, and cultures.
•The nurse must be sensitive to the differences in attitudes and practices of client and self

Question 26

Impact of Non-Therapeutic Communication

Answer 26

Blocking communication with clients
•Discouraging the client from expressing emotions openly
•Making the client feel defensive or requiring justification of actions
•Shifting the focus away from the client’s health concerns and experiences
•Belittling the client’s feelings and problems
•Avoiding exploration of critical topics
•Discouraging effective client decision-making
•Focusing on the problem and blaming rather than finding solutions, options, or insight

Question 27

Elements of non therapeutic communication

Answer 27

Using “why” questions
•Asking personal questions
• Giving personal opinions
• Changing the subject
• Automatic responses
• False reassurance
• Sympathy
• Asking for explanations
• Approval or disapproval
• Defensive responses
• Passive or aggressive responses
• Arguing

Question 28

Why not “why?”

Answer 28

Why demands an explanation:
“Why did you come home late?”
• Why implies wrongdoing
•It’s much more useful to ask what is happening rather than why it’s happening

Question 29

Personal Opinions/Advice

Answer 29

Nurses do not give personal opinions or advice
•Why?
•It takes the decision making away from the person
•Stalls problem solving, and creates doubt
•Patients will want to discuss care and options

Question 30

Sympathy

Answer 30

Sympathy is concern, sorrow, or pity felt for another person.
•“You probably feel devasted”
•May be compassionate, but not therapeutic.
•Sharing empathy
•Being emotional may prevent effective problem solving and impair good judgement

Question 31

What NOT to say

Answer 31

You should…”
• “You have to…”
• “You can’t…”
• “If it were me, I’d…”
• “Why don’t you…”
• “I think you…”
• “It’s the policy on this unit…”
• “Don’t worry…”
• “Everyone…”
• “Why…”

Question 32

Social communication

Answer 32

Informal interactions among friends, neighbors, and acquaintances

Question 33

Characteristics of social communication

Answer 33

*Usually occurs among people who know each other or are informally getting to know each other
* Does not necessarily focus on one person or one topic
* May or may not have an equal emphasis on all individuals or topics
* Involves mutual sharing of ideas, opinions, judgments, and feelings
* May have blurred boundaries at times
* Can express appropriate and inappropriate anger and humor
* Can have unsolidified (fluid) ethical and legal boundaries, depending on the circumstances
* Has little effect on the nurse–patient helping relationship, unless the nurse has a long history with the patient (which may be positive or negative)

Question 34

Therapeutic communication

Answer 34

Positive, beneficial interactions that focus on the patient

Question 35

Characteristics of therauperic communication

Answer 35

• Usually occurs among the patient, family members, and/or the health care team in a professional manner
• Focuses mainly on the patient
• Has an emphasis on the patient and health topics
• Has sharing but in a limited capacity from the nurse’s point of view
• Has clear boundaries on acceptable and unacceptable interactions
• unacceptable to express inappropriate anger and humor
• Maintains ethical and legal boundaries
• Has a positive effect on the nurse–patient helping relationship

Question 36

Non therapeutic communication

Answer 36

Negative, harmful interactions that are not focused on the patient’s needs

Question 37

Characteristics of non therapeutic communication

Answer 37

• Usually occurs among the patient, family members, and/or health care team in an unprofessional manner
• Does not focus on the patient
• Does not have an emphasis on the patient or health topics; may have too much inappropriate emphasis on the patient
• Has the ability for the nurse to overshare
• Usually crosses boundaries of acceptable interactions
• Crosses ethical and legal boundaries
• Expresses inappropriate behavior, anger, humor, or insensitivity
• Has an adverse effect on the nurse–patient helping relationship

Question 38

Requirements of HIPAA include the following:

Answer 38

No sharing of patient information (not even to family members) unless the patient or guardian has given permission
No sharing of patient conversations, except with the health care team when it relates to patient care
No talking about patients in public places (e.g., hallways, elevators, cafeteria)
No social media postings of patient information or images
No talking about patients with the nurse’s own friends, relatives, or neighbors

Question 39

Confidentiality

Answer 39

is an ethical and legal responsibility of nurses in both formal and informal interactions with patients.

Question 40

respect, assertiveness, advocacy, and professional boundaries are important in __________Communication

Answer 40

Theraupeutic

Question 41

The nurse can convey respect verbally and nonverbally. Asking a patient’s name preference during initial contact and using appropriate facial expressions and body language demonstrate respect. Common courtesy (using please and thank you) are additional ways to show respect. Considering what works best for patients individually, rather than generalizing care, is another aspect of respect.

Answer 41

Respect

Question 42

_______ communication by nurses demonstrates confidence and commands respect from patients and colleagues. Assertive nurses communicate regularly and use “I” statements. However, overly assertive nurses may be perceived as aggressive if they do not respect the rights and views of others.

Answer 42

Assertiveness communication

Question 43

Advocacy

Answer 43

The nurse is an advocate when defending the rights of patients, especially vulnerable patients, patients who cannot protect their own individual rights (anesthetized, comatose, confused), or those with whom the nurse disagrees philosophically. Assertiveness combined with clear and direct communication enhance advocacy efforts. As resources become increasingly limited, advocacy ensures patient access to needed services/supplies.

Question 44

Professional boundaries

Answer 44

Professional boundaries involve ethical and legal responsibilities that delineate the limits and responsibilities of nurses when caring for patients in any setting or facility. If nurses cross these boundaries, legal actions can be taken against the nurse and the nurse’s license. Allowing patients, guardians, or family members to have the nurse’s personal phone number, meeting/dating patients after discharge, and taking money/gifts for care violate professional boundaries. The nurse–patient helping relationship is therapeutic, not social.

Question 45

Reasons for avoiding nontherapeutic communication include:

Answer 45

Blocking communication with patients
Discouraging the patient from expressing emotions openly
Making the patient feel defensive or requiring justification of actions
Shifting the focus away from the patient’s health concerns and experiences
Belittling the patient’s feelings and problems
Avoiding exploration of critical topics
Discouraging effective patient decision-making
Focusing on the problem and blaming rather than finding solutions, options, or insight

Question 46

Nontherapeutic Techniques That Hinder Flow of Communication:

Answer 46

Using “why” questions

Asking closed-ended questions that can be answered with a “yes” or “no”

Changing the subject

Giving advice

Approving or disapproving

Agreeing or disagreeing

Offering false reassurance or false hope

Offering generalized responses

Offering excessive self-disclosure or comparison

Comparing patient experiences

Using personal terms of endearmen

There are several different nontherapeutic communication techniques that should be avoided. Some of these techniques limit the flow of communication and include the following:

Question 47

Offering false reassurance or false hope

Answer 47

Everything will be fine.”
“This medicine is nothing to be concerned about.”
“Don’t worry.”

Question 48

Offering generalized responses

Answer 48

It will work out.”
“You’re young enough; you can have more children.”
“You will be back to normal before long.”

Question 49

Offering excessive self-disclosure or comparison

Answer 49

I had the same type of surgery a couple of years ago.”
“I have several family members who died of cancer, too.”
“I am going through a bad divorce right now.”

Question 50

Comparing patient experiences

Answer 50

The patient in room 22 just had this treatment last week with no problems.”
“My aunt had this type of breast cancer and ended up having to remove a breast.”
“The patient down the hall has the same thing you do; maybe you will have some experiences in common.”

Question 51

Using terms of endearment

Answer 51

Honey/sweetheart.”
“Sweetie, it is time for your bath.”
“Sport, how about we take a stroll down the hall?”

Question 52

Has fluid ethical and legal boundaries

Answer 52

Social communication

Question 53

Has sharing but in a limited capacity from the nurse

Answer 53

Therapeutic communication

Question 54

Communication that has the focus on the nurse

Answer 54

Non therapeutic communication

Question 55

Examples of professional communications:

Answer 55

Nurse asks the patient’s name preference during initial contact
Respect

Nurse defends the rights of others, especially vulnerable patients
Advocacy

Nurse has confidence and commands respect
Assertiveness

Nurse keeps the nurse–patient relationship therapeutic, not social
Professional boundaries

Question 56

For which reason would the nurse avoid nontherapeutic communication in a nurse–patient helping (therapeutic) relationship?

Answer 56

requires justification of actions from the patient

Question 57

Developing a solid nurse–patient helping relationship through therapeutic communication involves:

Answer 57

Establishing trust
Exhibiting empathy
Setting boundaries
Identifying and honoring cultural beliefs and concerns
Creating a holistic plan of care

Question 58

Phases of the Nurse–Patient Helping Relationship

Answer 58

pre orientation
orientation/introductory,
working
termination.

Question 59

Pre orientation

Answer 59

Begins before the interaction
Activities include preparing to meet the patient by reading the chart or assessment, thinking about and planning the interaction, and identifying possible areas to address

Question 60

Orientation/Introductory

Answer 60

Begins the nurse–patient relationship
Activities include making introductions, setting roles and boundaries, observing/assessing patient, identifying patient’s needs followed by validation from patient, establishing trust, and establishing a tentative timeline

Question 61

Working

Answer 61

Begins the process of the nurse and patient addressing and solving needs/problems
Activities include creating and implementing plan of care, collaborating with others as needed, increasing rapport, using therapeutic communication to allow the patient to reflect on their illness and emotions, and explaining to the patient what is going to occur before and during any procedure or testing

Question 62

Termination

Answer 62

Begins the process of ending the relationship
Activities include saying “goodbye,” summarizing and evaluating care and outcomes, and discharging the patient home, to another unit or facility, or to a caregiver

Question 63

Factors Affecting Nurse–Patient Interactions:

Answer 63

*developmental statege
*proxemics
*culture
*distractions

Question 64

Proxemics

Answer 64

Interaction spaces and distances

Intimate (0 to 1.5 feet)
Personal (1.5 to 4 feet)
Social (4 to 12 feet)
Public (greater than 12 feet)

Question 65

Culture

Answer 65

Some cultures may be comfortable with close proxemics when communicating.
Some cultures may require a same-gender caregiver or want the family to help.
Some cultures may be uncomfortable with direct eye contact.
Some cultures do not want the top of the head touched.

Question 66

Distractions

Answer 66

Too many visitors and/or family members can sometimes make communicating difficult. The nurse has the right to ask the visitors/family members to leave because of confidentiality issues. However, if the patient wants the family members present, they can be allowed to stay.
Turning off the television and other electronic devices (cell phones, tablets, laptops) that are not essential for patient monitoring can help the nurse interact with the patient.

Question 67

Active listening

Answer 67

Use eye contact intermittently
Maintain eye level with patient
Use open posturing
Face the patient, if possible
Lean toward the speaking person
Avoid body movements that are distracting

Expresses interest and concern for the patient’s needs
Offers undivided attention to the patient

Question 68

Silence

Answer 68

Use of no words
Be present for the patient without verbal communication
Shows concern and caring for the patient in difficult or challenging situations
Gives the patient time to think and reflec

Question 69

Touch

Answer 69

Use discriminately in certain circumstances
Hold patient’s hand
Lightly touch patient’s arm, shoulder, or feet
Demonstrates empathy
Offers emotional supp

Question 70

Verbal Techniques That Initiate and Encourage Communication

Answer 70

Offering shelf
Calling patient by name
Sharing observations
Giving information
Open ended questions

Question 71

Sharing observations

Answer 71

You look worried.”
“You seem upset.”
“You are frowning.”

Question 72

Giving information

Answer 72

It is time for your medication.”
“My name is Samuel, and I will be the nurse taking care of you until 7 p.m.”
“Your test is scheduled for 8:30 a.m. tomorrow.”

Question 73

Open ended questions

Answer 73

What are your biggest concerns at this time?”
“How would you describe your general health status?”
“Tell me about some of the feelings you had after being diagnosed with cancer.”

Question 74

Verbal Techniques That Promote Understanding

Answer 74

Restating/paraphrasing

Seeking clarification

Summarizing

Validating

Question 75

Restating/paraphrasing

Answer 75

Patient: “I couldn’t eat supper last night.”
Nurse: “You couldn’t eat supper last night?” (restating)
Nurse: “You had trouble eating supper last night?” (paraphrasing)

Question 76

Seeking clarification

Answer 76

I don’t quite understand what you are saying.”
“What did you mean by your last comment?”

Question 77

Summarizing

Answer 77

There are three things that are bothering you: your weight, job, and finances.”
“We have covered some things that you are angry about, including…”

Question 78

Validation

Answer 78

Do I have this right that you…?”
“Do you mean that…?”

Question 79

Verbal Techniques That Promote Insight Rationalization

Answer 79

Allowing the patient to explore problems/issues in-depth
Gaining insight into a problem or issue
Producing emotional growth
Identifying progress
Increasing self-awareness

Question 80

Therapeutic Verbal Techniques That Promote Insight

Answer 80

Using focused questions or comments

Providing general leads

Conveying acceptance

Reflecting feelings

Using humor
Verbalizing the implied

Question 81

Match the phase of the nurse–patient helping relationship with its activity.

Answer 81

Collaborating among the nurse, patient, and others
Working

Transitioning to another caregiver
Termination

Predetermining topics of interaction
Preorientation

Observing, interviewing, and assessing patients
Orientation

Question 82

Which distance range (in feet) is considered social space in proxemics? Record your answer as whole numbers separated by a hyphen.

___________feet

Answer 82

4-12 feet

Question 83

Which behaviors would the nurse implement when using active listening?

Answer 83

Maintaining eye level with the patient

Keeping arms uncrossed

Facing the patient

Leaning toward the patient

Question 84

Match the verbal therapeutic technique to its example.

Answer 84

I’ll sit with you for a while.”
Offering self

“You seem frustrated.”
Sharing observations

“Tell me about some of your concerns.”
Using open-ended comments

“It is time for physical therapy.”
Giving information

Question 85

Which techniques promote therapeutic communication?

Answer 85

Conveying acceptance

Using focused comments

Using humor

Question 86

Some patients have conditions that make nonverbal or verbal communication—or both—difficult. Special skills and techniques are needed to effectively communicate with these patients. The nurse adapts to the patient’s limitations, identifying strengths and weaknesses that can assist in communication efforts.

Conditions that may affect communication include:

Answer 86

Hearing impairments
Visual impairments
Physical impairments
Cognitive impairments

Question 87

Various approaches can be used to communicate with a hearing-impaired patient:

Answer 87

Determine whether the patient uses a hearing aid, and check that the hearing aid, if used, is being used properly and that the batteries are charged.

Minimize background noise as much as possible.

Make sure that the area is well lit to improve the patient’s ability to read lips.
Speak as clearly as possible.

Raise normal voice level only slightly, using low tones (not high tones).

Stay within 3 to 6 feet of the patient to allow for observation of nonverbal cues.

Avoid turning away from the patient while talking; facing the patient allows the mouth and facial expressions to be seen and interpreted correctly.

Use a writing board, whiteboard, or computer as needed.

Question 88

When communicating with patients who have visual impairments, the nurse must be alert for possible hazards that may occur and anticipate any other dangers. If the patient has been blind for a period of time, auditory and olfactory senses are heightened to compensate for vision loss.

Techniques to use may include:

Answer 88

Describing the location of objects or potential hazards in the room

Using analog clock descriptors to specify location (“The phone is at 9 o’clock on the table.”) and for eating (“The meatloaf is in the 6 o’clock position, and your mashed potatoes are at 9 o’clock.”)

Using available tools for communication, such as large print, Braille, audio, and e-books to facilitate patient education

Speaking before touching or providing care to alert a blind patient to the nurse’s presence

Explaining in more detail about the procedure or assessment as it is taking place

Keeping eyeglasses available at all times for patients who wear them

Question 89

Communicating with patients who have physical and/or cognitive impairments can be challenging. Nurses must be flexible and adaptable. Patients with these conditions may be able to use

Answer 89

eye blinking, hand squeezing or head nodding, or written communication tools such as a whiteboard, tablet, or laptop.

Question 90

if the patient is comatose, semicomatose, under anesthesia, partially anesthetized, sedated, or seemingly unaware of their surroundings:

Answer 90

Continue to use physical touch.
Continue to communicate and teach the patient as though the patient can hear.
Allow friends and family to stay and talk to the patient.
Always speak before touching or providing care.
Observe for nonverbal signs of pain (grimacing) or restlessness (constant movement).
Use nonverbal signals, such as hand squeezes or eye movements, if the patient is able to provide them.

Question 91

The nurse can still communicate with patients requiring special equipment, including ventilators or tracheostomies, by using these techniques:

Answer 91

Use gestures, such as nods, shrugs, or eye movements, that communicate meaning (e.g., one blink for “yes” and two blinks for “no”).

If the patient is completely paralyzed, do not use hand squeezes (patient will not be physically able to perform).

Use assistive/electronic devices that can interpret gestures and eye movements and connect to computers.

Question 92

Although there are many types of cognitive impairments, patients with dementia (progressive mental deterioration, confusion) require special techniques.

Answer 92

Ask family members or other caregivers about effective strategies they have used to increase cooperation from the patient.

Gain as much insight into the lifelong habits of the patient to prevent disruption of familiar routines.
Do not confront or continually reorient the patient because this can increase agitation.

Reminisce with the patient.

When the patient is refusing all requests, distract the patient with an activity, such as walking or folding clothes, and then reintroduce the request.

Accept the patient’s erroneous thought processes rather than continually correcting the errors because the patient’s brain deterioration cannot process this information, leading to more confusion and agitation.

Question 93

Compensation

Answer 93

Using individual abilities or strengths to overcome feelings of inadequacy

Question 94

Denial

Answer 94

Refusing to admit the reality of a situation or feeling

Question 95

Displacement

Answer 95

Transferring emotional energy away from an actual source of stress to an unrelated person or object

Question 96

Introjection

Answer 96

Taking on certain characteristics of another individual’s personality

Question 97

Projection

Answer 97

Attributing undesirable feelings to another person

Question 98

Rationalization

Answer 98

Denying true motives for an action by identifying a more socially acceptable explanation

Question 99

Regression

Answer 99

Reverting to behaviors consistent with earlier stages of development

Question 100

Repression

Answer 100

Storing painful or hostile feelings in the unconscious, causing them to be “forgotte

Question 101

Sublimination

Answer 101

Rechanneling unacceptable impulses into socially acceptable activities

Question 102

Suppression

Answer 102

Choosing not to think consciously about unpleasant feelings (this is the only defense mechanism that is not unconscious)

Question 103

Patient does not speak the same language as the nurse.

Answer 103

Obtain an interpreter.
Use face-to-face, phone, or video platforms for the interpreter.
Do not use family members because it breaches confidentiality and may lead to misinterpretation of medical information.
Follow the facility’s policies and procedures for this situation.

Question 104

Patient is lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+).

Answer 104

Use pronouns (he, she) that the patient has identified as rather than those reflective of sex at birth.
Be nonjudgmental and respectful.
Continue to use appropriate touch for comfort.

Question 105

Patient is in moderate to severe pain and/or has anxiety.

Answer 105

Use short and direct sentences, questions, or instructions.
Avoid teaching during these times (learning does not occur).
Do not leave severely anxious patients alone because it will make the anxiety worse.

Question 106

The same therapeutic communication techniques described for patients can be used with families and members of the patient’s supportive relationships and may provide insight into

Answer 106

Family or supportive relationship dynamics
Effects of illness on the patient’s family or members of the patient’s supportive relationships
Presence and availability of support systems

Question 107

Match the defense mechanism to its definition.

Answer 107

Refusing to admit the reality of a situation
Denial
Using personal strengths to overcome feelings of inadequacy
Compensation
Choosing not to think consciously about unpleasant feelings
Suppression
Taking on certain characteristics of another
Introjection

Question 108

Which important patient insight may be gained by communicating with family members?

Answer 108

recognizing the existence of support systems

Question 109

related to patient education emphasizes that education should be appropriate for the patient’s condition and delivered according to the patient’s needs and abilities

Answer 109

The joint commission standards

Question 110

The following areas are commonly associated with health literacy:

Answer 110

Patient/health care provider communication (information related to medical terms/health condition)
Medication labels and medication instructions
Informed consent for treatment
Medical and insurance forms
Personal health history and reporting of symptoms
Written educational materials, such as handouts or pamphlets

Question 111

Patients with low health literacy are more likely to :

Answer 111

Increased rates of hospitalization
Poor adherence to treatment plans, a situation that results in higher health care costs
Lower usage of preventive health care services
Medication and treatment errors
Poor adherence to outpatient appointments and follow-up care

Question 112

Outcomes Associated with Higher Health Literacy

Answer 112

Greater understanding and perception of the patient’s chronic illness and of related health care decisions

Better self-management, which leads to better health outcomes

Lower emotional stress associated with unknowns about the illness and care

Question 113

High-risk groups for low health literacy include the following:

Answer 113

Older adults
Those who speak English as a second language
Immigrants
Members of lower socioeconomic class
Homeless individuals
Prison population
People with limited formal education

Question 114

low health literacy,

Answer 114

based on their ability to understand medical concepts required for personal decision-making. People with low health literacy are unable to comprehend health-related terminology and understand written health care instructions. They have difficulty understanding medical concepts necessary for informed decision-making.

Question 115

Components of Health Literacy

Answer 115

Communication
Reading comprehension
Numeracy
Technology

Question 116

Oral communication in low health literacy

Answer 116

Oral communication is the ability to send and receive information.
Does the patient have any impairments such as vision or hearing difficulties?
Does the patient speak English, or is English a second language? Would an interpreter be beneficial?
Should educational material be presented in a verbal, visual, or written form, or in all three forms?

Question 117

Reading Comprehension in low health literacy

Answer 117

Written material is presented with the assumption that the patient not only can read the material but also can understand what is written.
Most preprinted health-related information is designed for comprehension at the fifth-grade reading level.
It is important to recognize that some patients may require simpler written instructions.

Question 118

Numeracy in low health literacy

Answer 118

Numeracy is the ability to understand numeric data and to use the data to make health-related decisions.
Numeric data could include statistical information, information in a graph, or test results indicating low blood sugar.
Numeric information may also require the ability to tell time and to know when to take medication.

Question 119

Technology in low health literacy

Answer 119

Educational material is now delivered electronically and digitally.
The patient must know how to navigate technological devices, such as a cell phone used for text messaging or a computer used to visit a website.
Electronic health materials can impact low-literacy patients in a positive way with audiovisual presentations.

Question 120

According to the Healthy People 2020 initiative, patients who are proficient in health literacy should be able to demonstrate the following competencies:

Answer 120

Read and identify credible health information:
Written materials and websites from well-known professional organizations versus websites that may promote unorthodox or harmful solutions for diseases and conditions.
Understand numbers in the context of their health care:
Dosages on medication labels or calculations, if required.
Make appointments:
Contact the correct health care provider or facility.
Fill out forms and obtain health records:
Involves reading forms and entering correct information.
Asking appropriate questions of health care providers.
Advocate for appropriate care:
Involves knowing what appropriate care includes, whom to contact for that care, and how to get that care.
Navigate complex insurance programs, Medicare or Medicaid, and other financial assistance programs:
Involves understanding of these programs, how to access agency representatives, and how to complete any necessary forms.
Use technology to access information and services (DHHS, 2010):
Involves assessing use of programs required to access needed services

Question 121

Healthy people 2020 objectives

Answer 121

The first objective stresses the need for an increase in the proportion of patients who report that their health care providers always provide easy-to-understand guidance about their health and illness concerns

The second objective states that health care providers and organizations need to demonstrate an increase in the number of patients reporting that their health care providers always confirm that they understand and are capable of following the information that was presented.

The third objective states that there must be an increase in the number of patients who report that the offices of their health care providers always offer to help fill out necessary medical paperwork (Ling, 2021).

Question 122

Patient education (nurses)

Answer 122

It involves explaining how the medication works, why it is necessary, and what may occur if the patient is nonadherent

Question 123

Quality patient education

Answer 123

teaches the patient how to make changes and why the changes are necessary, and it gives the patient the skills needed to implement changes

Question 124

Patient Education Challenges

Answer 124

Decreased lengths of stays (shorter amounts of time to teach)
Limited time during outpatient clinic visits
Limited or lack of teaching materials/supplies
Conflicting information received by patients who seek information from the Internet, other primary health care providers, or other health care disciplines
Complex patient care needs and a nurse who may have limited training/skills to provide the necessary education
Low patient health literacy and/or low patient literacy
Anxiety, stress, or medications affecting mental capacity
Patient’s lack of readiness to learn

Question 125

Barriers to Effective Patient Education

Answer 125

A nurse’s lack of awareness about a patient’s level of health literacy
Lack of time to answer questions or to repeat complicated material
Inaccurate simplification of complex information
Concerns about offending the learner due to culture/race
Staff turnover, which leads to inadequate educational training of new nurses
A nurse’s belief that particular information is not vital and does not need to be taught

Question 126

Which outcomes are often associated with low health literacy?

Answer 126

Taking prescribed medications incorrectly

Missing follow-up appointments

Higher health care costs

Poor adherence with treatment plans

Question 127

Which patient would the nurse recognize as having the highest risk for low health literacy?

Answer 127

25-year-old undocumented migrant worker

Question 128

Which actions indicate proficiency in health literacy?

Answer 128

Understanding which websites are appropriate to use for health information

Understanding benefits of Medicare programs

Being able to call and schedule follow-up appointments

Navigating a smartphone to input a medication list into an app

Question 129

Teaching Commonly Applied Theories

Answer 129

Behavioral, cognitive, change and humanist theories

Question 130

Behavioral Theories

Answer 130

Some of the most common theories believe learning should focus on observable behaviors.

Question 131

Cognitive Theories

Answer 131

These theories believe that internal processes must occur for the learner to begin understanding presented information.

Question 132

Change Theorie

Answer 132

Learners must be assessed for readiness to learn before presentation of the educational material so that behavioral changes may be implemented.

Question 133

Humanistic Theories

Answer 133

The learner must be self-motivated in addition to being able to self-evaluate with clear-cut goals and outcomes (Stephens, 2016).

Question 134

examples of nurse-taught formal education include:

Answer 134

Childbirth classes for a group of expectant mothers
Class for nursing students on the proper methods of obtaining vital signs
Demonstration for patient on caring for a surgical incision before discharge
CPR classes for other health care employees

Question 135

Informal patient education examples

Answer 135

The patient or caregiver might ask a question about a procedure, medication, or treatment while the nurse is at the bedside. The nurse uses the question as an informal teaching opportunity. In this case, there is no specific structure and there are no preset goals for the teaching session. The patient is free to continue asking questions that direct the teaching session. Informal teaching is particularly effective because it is based on learner need. It indicates that the patient or caregiver is motivated and ready to learn.

Patient questions that might prompt informal teaching sessions include, but are not limited to:

What does this medication do?
How long will the procedure take?
What happens during this test?
Does this medication cause side effects?
Will the procedure hurt?

Question 136

Teach-Back to Assess for Understanding

Answer 136

“Teach-Back” to Assess for Understanding
Goal: Effective child and family self-management

• Teach new concept or skill Repeat new learning in own words or
demonstrate new skill (“teach-back”) @ Clarify or correct misunderstood
information
— Repeat corrected information
• “What questions do you have?” • Continue process until concept
or skill is understood

Question 137

Self-directed learning occurs

Answer 137

when individuals seek the information themselves instead of waiting for the information to be taught.

Question 138

Collaborative learning occurs

Answer 138

over time through multiple interactions with others such as nurses, respiratory therapists, and primary health care providers.

Question 139

Incidental learning occurs

Answer 139

through mistakes and motivates the learner to engage in finding more information about why the mistake happened.

Question 140

When learners participate in their own learning

Answer 140

they usually obtain a greater amount of knowledge. This is the basis behind support groups, such as weight-loss groups, bereavement groups, and addiction groups.

Question 141

Elements Hindering the Learning Process

Answer 141

Negative Effects on Motivation to Learn
Cognitive Ability
Cultural Influences
Emotional Barriers
Ineffective Communication

Question 142

Negative Effects on Motivation to Learn

Answer 142

Belief that goals are unattainable
Lack of trust in the nurse–patient relationship
Denial of current illness
Too many distractions
Feeling overwhelmed by too much information

Question 143

Cognitive Ability hindering in the learning process

Answer 143

Age
Brain injury
Developmental delay
Medication side effects
Low literacy

Question 144

Cultural influences Hindering in the learning process

Answer 144

Lack of a support system
Cultural influences that do not support wellness
Religious or spiritual influences
Individual cultural beliefs about wellness

Question 145

Emotional barriers in the learning process

Answer 145

Stress about finances, health
Anxiety about new diagnosis
Anxiety about loss of independence
Recent loss—divorce, death of family member
Depression

Question 146

Ineffective communication in the learning process

Answer 146

Language barrier
Hearing impairment
Vision impairment
Speech impairment (jaw wired shut, history of stroke)

Question 147

Teaching Styles

Answer 147

Questioning
Lecture
Demonstration
Group Discussion
Role-Playing

Question 148

Questioning technique as teaching style

Answer 148

The questioning technique requires the teacher to present information in a way that promotes critical thinking. Clearly phrased questions enhance the learner’s ability to put pieces of information together and arrive at an “aha” moment. “Have you noticed an increase in your child’s asthma exacerbations when she is around her grandparents who smoke?” The teacher then continues to ask direct questions that further the learner’s ability to make the connection.

Question 149

Lecture as teaching style

Answer 149

In the lecture style of teaching, the information is usually presented to individuals who already have a basis of knowledge about the topic. Printed material is often given to supplement the formal lecture.

Question 150

Demonstration as teaching style

Answer 150

With the demonstration teaching technique, the teacher performs a task for an individual or a group of individuals. The hands-on demonstration may occur in a live session, or it may be prerecorded for learners to view individually. With video-recorded demonstrations, learning is enhanced if the teacher is available for interactive questions after the video has been watched. Additionally, because video-recorded demonstrations can often fail to engage the learner, humor or other stimulating tactics are necessary to make the video-recorded teaching style successful.

Question 151

Group discussion as teaching style

Answer 151

Group discussions allow the educator to lead a purposeful conversation among individuals engaged and interested in the same topic or idea. The group discussion technique is great for allowing the learner to share individual opinions and experiences, a situation that encourages the participant to take an active role in the learning process.

Question 152

Role playing as teaching style

Answer 152

Role-playing requires participants to recreate an environment similar to a real-life situation. It allows the learner to have an up-close and personal experience and engages the learner in the teachable moment.

Question 153

Domains of learning

Answer 153

cognitive, psychomotor, and affective.

Question 154

Cognitive domain

Answer 154

The cognitive domain requires memorization and recollection of presented material to understand, apply, analyze, and evaluate the information. A patient who learns in the cognitive domain remembers educational information that was taught, can repeat the information, and ask follow-up questions about the presented material.

Examples:

Teaching carbohydrate counting to a new diabetic
Knowing the signs of infection with a ventricular assist device (VAD)
Knowing signs and symptoms of heart failure

Question 155

Psychomotor domain

Answer 155

Learners who gain knowledge in the psychomotor domain use physical movement or motor skills during the teachable moment.

Examples:

Learning to check a blood glucose level for a new diabetic
Learning to change a VAD dressing
Obtaining accurate daily weight for the patient with heart failure

Question 156

Affective domain of learning

Answer 156

The affective domain recognizes the importance of the emotions involved when learning new material. Successful teaching in this domain requires the teacher to understand a learner’s emotions, motivation, and attitude as well as their effects on the value of the presented material.

Examples:

Exploring the feelings associated with self-administering insulin
Discussing importance of VAD dressing changes in the prevention of infections
Discussing patient’s feelings about the need to significantly change diet to maintain better health

Question 157

Styles of Learning

Answer 157

visual learning;
auditory learning;
reading/writing;
and kinesthetic, or tactile, learning.

Question 158

Strategies to ensure effectiveness of patient education include

Answer 158

Encourage patients and their families to participate actively as part of patient-centered care.
Ensure that patients and their families understand the information presented to them.
Provide patients and their families with materials aligned with their learning styles, reading levels, and preferred languages.
Speak in a clear, distinct voice, and use understandable terminology when teaching patients and their families.
Use multiple teaching methods to accommodate learning styles of all learners.
Stop after covering two to three key points to ensure that the patient is still engaged and able to process more information. Reassess knowledge of the patient and/or family members after each teaching session to determine if learning has occurred or if teaching needs to be repeated.
Review information taught at previous sessions before proceeding with new material.
Ask questions that indicate comprehension (e.g., the teach-back method) to determine whether patients and/or family understood the material.

Question 159

strategies that can promote a positive learning environment include the following tips:

Answer 159

Address the patient and family by name and maintain good eye contact (if culturally appropriate).
Pick a quiet setting with limited interruptions.
Confirm the goal(s) of the teachable moment (desired outcome).
Ensure the patient’s readiness to learn (free of pain and stress). Avoid conducting education sessions immediately after surgery or delivery of a difficult diagnosis.
Encourage questions even if the same questions are repeated.
Keep the patient/family engaged in the presented material.
Keep the teachable moment brief and focused.
Give positive reinforcement.

Question 160

Considerations for Patients with Poor Health Literacy

Answer 160

Use plain language and simple terms.
Teach only the necessary information.
Teach the most important information first.
Condense information to avoid overwhelming a patient.
Confirm that written material is at an appropriate grade level.
Use multiple formats to present the information.

Question 161

Which strategies can the nurse use to increase the effectiveness of the education process?

Answer 161

Involve family members in the teaching process.

Cover only two to three key points at a time.

Review previous information before starting new material.

Encourage the patient to ask questions.

Question 162

Which statement indicates that the nurse needs additional education about teaching and learning styles?

Answer 162

When teaching, I will include the three distinct styles of learning: visual, auditory, and reading and writing.”

Question 163

Patient education in the hospital setting can be challenging due to which factors

Answer 163

Lack of patient readiness to learn

Sedation related to medications

Lack of skill required for patient teaching

Question 164

Which statement by the nurse indicates understanding of the definition of health literacy?

Answer 164

A patient with low health literacy is unable to understand the medical information necessary for health care decision-making

Question 165

Which examples illustrate formal teaching in health care?

Answer 165

CPR certification taught to a pediatrician’s office staff

Infant parenting class at the local hospital

Teaching the patient and family signs of a wound infection during the discharge process

Question 166

Which outcomes have been associated with increased health literacy?

Answer 166

Improved health outcomes

Increased clarity about future decisions related to illness

Improved medication adherence

Increased adherence to treatment plan

Question 167

Which abilities are required for a person to be considered as having higher health literacy?

Answer 167

Filling out a health questionnaire

Solving simple mathematical equations

Reading discharge instructions

Following medication instructions

Question 168

Which method would be most effective when teaching a patient recently diagnosed with diabetes to check blood glucose levels?

Answer 168

Have the patient perform the step-by-step instructions with guidance from the nurse.

Question 169

Which statement by the nurse is appropriate when discussing how best to teach a Spanish-speaking patient about the signs and symptoms of heart failure?

Answer 169

In addition to a medical translator, I want to make sure at least one family member or caregiver is present when I am teaching the patient.

Question 170

Which domain of learning is addressed when the nurse teaches a patient to take a pulse and then has the patient demonstrate the skill?

Answer 170

Psychomotor

Question 171

Word Recognition Tests

Answer 171

Word recognition tests are literacy tests that give a patient an allotted amount of time to read health-related terminology.

Question 172

Recognizing Health Literacy Cues

Answer 172

socioeconomic characteristics that can be associated with low health literacy,
directly asking the patient about ability to understand oral and written health-related information.
A common occurrence when assessing a patient’s literacy is assuming that wealth or formal education equates with higher health literacy levels. It is important to remember that socioeconomic status and educational level do not always correlate with the ability to understand and process medical terminology and health-related information.

Question 173

When assessing the learner, it is important to assess:

Answer 173

Current level of knowledge
Age/developmental level
Preferred language
Preferred style of learning
Readiness to learn/motivation level
Current anxiety or stress level
Current overall health/well-being
Current beliefs associated with wellness

Question 174

Questions with a patient education focus include:

Answer 174

What is your preferred language?”
“Do you like to read books, magazines, or newspapers?”
“Do you have any family members or caregivers we should include in the education process?”
“Do you have access to the Internet?”
“How do you learn best—watching videos, reading information, or using a hands-on approach?”

Question 175

Open-Ended Questions

Answer 175

Open-ended questions such as “Can you tell me about your medications?” will help the nurse determine whether the patient knows the names of current medications and the conditions that the medications treat or the patient is just taking a blue pill every morning. Open-ended questions will also allow the patient to talk about the illness and identify additional information that should be presented to increase the patient’s health literacy level.

Question 176

Behavioral Cues to Low Literacy

Answer 176

Makes excuses:
“I forgot my glasses.”
“I want my daughter to be present to read it with me.”
“I would rather take it home to read it.”
Points to text as they read
Mouths words as they read
Refers to medications by description of the pill instead of the name
Opens the medication bottle to show the pill instead of naming the medication
Watches for others’ behavior or responses before talking
Does not complete forms or has family members fill out necessary information
Pretends to read the information (acts as if reading/eyes wander over a page)
Will not sign consent forms for treatment/postpones decision-making until family can be present
Seems noncompliant (does not follow up with scheduled appointments or take medications correctly)
Has laboratory results that do not correlate with expectations if patient is adhering to the treatment plan as stated

Question 177

Educational Assessment Checklist

Answer 177

Age, developmental level, and cognitive ability
Physical limitations (visual, auditory, language skills/speech impediments)
Educational background
Cultural experiences (home environment, spiritual beliefs, occupation)
Finances and insurance coverage
Social support (family, friends, church)
Emotional issues (pain, anxiety, stress, depression)
Readiness to learn

Question 178

What cues may indicate low literacy?

Answer 178

Did not graduate high school
Could not name his medications
Refuses to read educational material left at the bedside

Question 179

What cues may affect his readiness to learn?

Answer 179

Financial stress: chose work over outpatient follow-up appointment and chooses fast food over vegetables due to cost
Denial related to new diagnosis: does not believe he will need a heart transplant
Lack of family or social support: lives with grandparents and was discharged home from his previous admission without social support
Seems withdrawn: does not interact with nursing staff and is always on his phone

Question 180

What cues may indicate low health literacy?

Answer 180

TOFHLA score of 50. A score less than 53 indicates low health literacy
Did not keep follow-up appointment because he was feeling good at the time
Lack of understanding about his grandfather’s heart condition and his own diagnosis
Does not think he will need a heart transplant
No dietary changes made after discharge
Could not verbalize which medication treated which symptom or give the names of his medications

Question 181

When would the nurse assess the patient’s health literacy?

Answer 181

During each patient interaction

Question 182

Which patient behaviors could indicate low health literacy?

Answer 182

Wants to wait for family before signing consent form

Has laboratory results that do not support the patient’s prescribed treatment plan

Refers to medications by the color of the pill

Frequently misses follow-up appointments

Question 183

Which question would be most appropriate for the nurse to ask when trying to gauge the patient’s current knowledge of health care needs

Answer 183

Which medications do you take for your high blood pressure?”

Question 184

Teaching Approaches

Answer 184

Telling
Participating
Entrusting
Reinforcing

Question 185

Telling

Answer 185

Telling is the approach used during the moments when there is limited time available for teaching. The nurse needs to be direct and to the point and to make sure the patient understands the information. The material should be clear and precise because there is limited opportunity for the patient to engage in the teachable moment. For example, an emergency department nurse would use telling to explain the need for a nonrebreather oxygen mask to a patient having a severe asthma exacerbation.

Question 186

Participating

Answer 186

Participating is the approach used when both the patient and the nurse are involved in the learning process. This type of approach is most common when providing important medical education. An example of the participating approach would be teaching the mother of a child with hypoplastic left heart syndrome the signs and symptoms of heart failure.

Question 187

Entrusting

Answer 187

The entrusting approach is seen when the patient is given the opportunity to manage personal care. The nurse is available for teaching, if needed, but trusts that the patient has the knowledge to manage care independently. This might be seen in the patient who has a known history of asthma and receives a new maintenance medication to add to his or her current medications. The nurse may need to give initial instructions but knows the patient is competent and able to use a metered-dose inhaler independently.

Question 188

Reinforcing

Answer 188

Reinforcing is the positive (or negative) stimulus that produces a desired response. An example of reinforcing is smiling or giving an encouraging nod when the patient does well learning a new skill.

Question 189

Components of Patient Education Goals

Answer 189

The three components that are necessary when creating patient education goals are identifying who will accomplish the goal, which action will be accomplished, and what final outcome is to be evaluated. The verb should be measurable, concrete, and clearly stated so that the desired outcome can be evaluated for completeness of the task. By keeping it simple and concrete, it easily allows for the patient to understand what is expected. Goals can be related to behavioral lifestyle changes, increased knowledge, or psychomotor skills to be learned.

Question 190

Developing Educational Plans

Answer 190

Lack of Knowledge and Interventions
Attitude
Skill Level
Physical Impairments
Native Language
Previous

Question 191

Which descriptors are accurate for an appropriately written patient education goal?

Answer 191

Specific

Patient-centered

Measurable

Individualized

Question 192

A patient in the emergency department with known supraventricular tachycardia starts experiencing shortness of breath and is no longer tolerating the dysrhythmia. Which teaching approach is most likely to be used when informing the patient about the need for cardioversion?

Answer 192

Telling

Question 193

Match the teaching approach to its description.

Answer 193

Patient is given opportunity to manage personal care
Entrusting
Patient and nurse are both involved in the learning process
Participating
Nurse presents direct, clear, and precise information to the patient
Telling
Nurse provides a stimulus that produces a desired response
Reinforcing

Question 194

Nursing interventions for patient education include the following:

Answer 194

Determine who will be the learner (patient, family member, caregiver).
Assess motivation and willingness to learn.
Assess ability to learn.
Identify priority of learning needs.
Identify any existing misconceptions.
Determine patient’s learning style.
Provide quiet learning environment.
Establish objectives and goals of learning at each teaching session.
Allow learner to identify what they most want to learn.

Question 195

Creating an Optimal Learning Environment

Consider the following characteristics when choosing a setting for education:

Answer 195

Quiet and free from distractions
Private
Comfortable with appropriate furniture
Adequately lit
Adequately ventilated, neither too hot nor too cold
Roomy with ample space, especially for teaching skills or providing demonstrations

Question 196

Selecting Teaching Modalities

Answer 196

Providing the best way to deliver the educational information is important. Identifying how the patient learns best can be key for patient retention and understanding. As discussed earlier, patients can learn from reading, watching videos, doing hands-on demonstrations, and having informal discussions

Question 197

Many methods exist to improve understanding of difficult information, including:

Answer 197

Using short sentences
Using simple words (“breathing fast” instead of “tachypnea”)
Using bullet points
Limiting written information to most important points
Dividing the document into manageable chunks of information
Being specific by focusing on two to three key pieces of information at a time
Using simple pictures and drawings
Showing relationships through pictures, if applicable

Question 198

Teach-Back Method

Answer 198

New concept
Nurse explanation
Patient verbalizes what was hear
Nurse clarify any miss information
Nurse clarifies patient’s understanding: can you tell me in your own words
Patient verbalizes understanding and remember clinical information