UNIT F

Question 1

A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “This patient is like one of my grandparents … so helpless.” Which response is the nurse demonstrating?

a. Transference
b. Countertransference
c. Catastrophic reaction
d. Defensive coping reaction

Answer 1

ANS: B
Countertransference is the nurse’s transference or response to a patient that is based on the nurse’s unconscious needs, conflicts, problems, or view of the world. See relationship to audience response question.

Question 2

Which statement shows a nurse has empathy for a patient who made a suicide attempt? a. “You must have been very upset when you tried to hurt yourself.”

b. “It makes me sad to see you going through such a difficult experience.”
c. “If you tell me what is troubling you, I can help you solve your problems.”
d. “Suicide is a drastic solution to a problem that may not be such a serious matter.”

Answer 2

ANS: A
Empathy permits the nurse to see an event from the patient’s perspective, understand the patient’s feelings, and communicate this to the patient. The incorrect responses are nurse-centered (focusing on the nurse’s feelings rather than the patient’s), belittling, and sympathetic.

Question 3

After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?

a. The patient’s reactions toward the nurse seem realistic and appropriate.
b. The patient states, “Talking to you feels like talking to my parents.”
c. The nurse feels unusually happy when the patient’s mood begins to lift.
d. The nurse develops a trusting relationship with the patient.

Answer 3

ANS: C
Strong positive or negative reactions toward a patient or over-identification with the patient indicate possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference and then seek supervision. Realistic and appropriate reactions from a patient toward a nurse are desirable. One incorrect response suggests transference. A trusting relationship with the patient is desirable. See relationship to audience response question.

Question 4

A patient says, “Please don’t share information about me with the other people.” How should the nurse respond?
a. “I will not share information with your family or friends without your permission,
but I will share information about you with other staff.”
b. “A therapeutic relationship is just between the nurse and the patient. It is up to you
to tell others what you want them to know.”
c. “It depends on what you choose to tell me. I will be glad to disclose at the end of
each session what I will report to others.”
d. “I cannot tell anyone about you. It will be as though I am talking about my own
problems, and we can help each other by keeping it between us.”

Answer 4

ANS: A
A patient has the right to know with whom the nurse will share information and that
confidentiality will be protected. Although the relationship is primarily between the nurse
and patient, other staff needs to know pertinent data. The other incorrect responses promote
incomplete disclosure on the part of the patient, require daily renegotiation of an issue that should be resolved as the nurse–patient contract is established, and suggest mutual problem solving. The relationship must be patient centered. See relationship to audience response question.

Question 5

A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, “I really need to talk to you.” The nurse should

a. invite the interrupting patient to join in the session with the current patient.
b. say to the interrupting patient, “I am not available to talk with you at the present time.”
c. end the unproductive session with the current patient and spend time with the interrupting patient.
d. tell the interrupting patient, “This session is 5 more minutes; then I will talk with you.”

Answer 5

ANS: D
When a specific duration for sessions has been set, the nurse must adhere to the schedule. Leaving the first patient would be equivalent to abandonment and would destroy any trust the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted and that the patient and the sessions are important. The incorrect responses preserve the nurse–patient relationship with the silent patient but may seem abrupt to the interrupting patient, abandon the silent patient, or fail to observe the contract with the silent patient.

Question 6

Termination of a therapeutic nurse–patient relationship has been successful when the nurse
a. avoids upsetting the patient by shifting focus to other patients before the discharge.
b. gives the patient a personal telephone number and permission to call after
discharge.
c. discusses with the patient changes that happened during the relationship and
evaluates outcomes.
d. offers to meet the patient for coffee and conversation three times a week after
discharge.

Answer 6

ANS: C
Summarizing and evaluating progress help validate the experience for the patient and the
nurse and facilitate closure. Termination must be discussed; avoiding discussion by
spending little time with the patient promotes feelings of abandonment. Successful
termination requires that the relationship be brought to closure without the possibility of
dependency-producing ongoing contact.

Question 7

What is the desirable outcome for the orientation stage of a nurse–patient relationship? The patient will demonstrate behaviors that indicate

a. self-responsibility and autonomy.
b. a greater sense of independence.
c. rapport and trust with the nurse.
d. resolved transference.

Answer 7

ANS: C
Development of rapport and trust is necessary before the relationship can progress to the working phase. Behaviors indicating a greater sense of independence, self-responsibility, and resolved transference occur in the working phase.

Question 8

During which phase of the nurse–patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?

a. Preorientation
b. Orientation
c. Working
d. Termination

Answer 8

ANS: C
During the working phase, the nurse strives to assist the patient in making connections among dysfunctional behaviors, thinking, and emotions and offers support while alternative coping behaviors are tried.

Question 9

At what point in the nurse–patient relationship should a nurse plan to first address termination?

a. During the orientation phase
b. At the end of the working phase
c. Near the beginning of the termination phase
d. When the patient initially brings up the topic

Answer 9

ANS: A
The patient has a right to know the conditions of the nurse–patient relationship. If the
relationship is to be time-limited, the patient should be informed of the number of sessions.
If it is open-ended, the termination date will not be known at the outset, and the patient
should know that the issue will be negotiated at a later date. The nurse is responsible for bringing up the topic of termination early in the relationship, usually during the orientation phase.

Question 10

A nurse introduces the matter of a contract during the first session with a new patient because contracts

a. specify what the nurse will do for the patient.
b. spell out the participation and responsibilities of each party.
c. indicate the feeling tone established between the participants.
d. are binding and prevent either party from prematurely ending the relationship.

Answer 10

ANS: B
A contract emphasizes that the nurse works with the patient rather than doing something for the patient. “Working with” is a process that suggests each party is expected to participate and share responsibility for outcomes. Contracts do not, however, stipulate roles or feeling tone, and premature termination is forbidden.

Question 11

As a nurse escorts a patient being discharged after treatment for major depression, the patient gives the nurse a necklace with a heart pendant and says, “Thank you for helping mend my broken heart.” Which is the nurse’s best response?
a. “Accepting gifts violates the policies and procedures of the facility.”
b. “I’m glad you feel so much better now. Thank you for the beautiful necklace.”
c. “I’m glad I could help you, but I can’t accept the gift. My reward is seeing you
with a renewed sense of hope.”
d. “Helping people is what nursing is all about. It’s rewarding to me when patients
recognize how hard we work.”

Answer 11

ANS: C
Accepting a gift creates a social rather than therapeutic relationship with the patient and blurs the boundaries of the relationship. A caring nurse will acknowledge the patient’s gesture of appreciation, but the gift should not be accepted. See relationship to audience response question.

Question 12

Which remark by a patient indicates passage from orientation to the working phase of a nurse–patient relationship?

a. “I don’t have any problems.”
b. “It is so difficult for me to talk about problems.”
c. “I don’t know how it will help to talk to you about my problems.”
d. “I want to find a way to deal with my anger without becoming violent.”

Answer 12

ANS: D
Thinking about a more constructive approach to dealing with anger indicates a readiness to make a behavioral change. Behavioral change is associated with the working phase of the relationship. Denial is often seen in the orientation phase. It is common early in the relationship, before rapport and trust are firmly established, for a patient to express difficulty in talking about problems. Stating skepticism about the effectiveness of the nurse–patient relationship is more typically a reaction during the orientation phase.

Question 13

A nurse explains to the family of a mentally ill patient how a nurse–patient relationship differs from social relationships. Which is the best explanation?
a. “The focus is on the patient. Problems are discussed by the nurse and patient, but
solutions are implemented by the patient.”
b. “The focus shifts from nurse to patient as the relationship develops. Advice is
given by both, and solutions are implemented.”
c. “The focus of the relationship is socialization. Mutual needs are met, and feelings
are shared openly.”
d. “The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other.”

Answer 13

ANS: A
Only the correct response describes elements of a therapeutic relationship. The remaining responses describe events that occur in social or intimate relationships.

Question 14

A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should

a. restate what the patient says.
b. use congruent communication strategies.
c. use self-revelation in patient interactions.
d. consistently interpret the patient’s behaviors.

Answer 14

ANS: B
Genuineness is a desirable characteristic involving awareness of one’s own feelings as they arise and the ability to communicate them when appropriate. The incorrect options are undesirable in a therapeutic relationship.

Question 15

A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of
anger toward the patient. The nurse should
a. suppress the angry feelings.
b. express the anger openly and directly with the patient.
c. tell the nurse manager to assign the patient to another nurse.
d. discuss the anger with a clinician during a supervisory session.

Answer 15

ANS: D
The nurse is accountable for the relationship. Objectivity is threatened by strong positive or negative feelings toward a patient. Supervision is necessary to work through countertransference feelings.

Question 16

A nurse wants to enhance growth of a patient by showing positive regard. The nurse’s action most likely to achieve this goal is

a. making rounds daily.
b. staying with a tearful patient.
c. administering medication as prescribed.
d. examining personal feelings about a patient.

Answer 16

ANS: B
Staying with a crying patient offers support and shows positive regard. Administering daily medication and making rounds are tasks that could be part of an assignment and do not necessarily reflect positive regard. Examining feelings regarding a patient addresses the nurse’s ability to be therapeutic.

Question 17

A patient says, “I’ve done a lot of cheating and manipulating in my relationships.” Select a nonjudgmental response by the nurse.

a. “How do you feel about that?”
b. “I am glad that you realize this.”
c. “That’s not a good way to behave.”
d. “Have you outgrown that type of behavior?”

Answer 17

ANS: A
Asking a patient to reflect on feelings about his or her actions does not imply any judgment about those actions, and it encourages the patient to explore feelings and values. The remaining options offer negative judgments.

Question 18

A patient says, “People should be allowed to commit suicide without interference from

others. ” A nurse replies, “You’re wrong. Nothing is bad enough to justify death.” What is the best analysis of this interchange?
a. The patient is correct.
b. The nurse is correct.
c. Neither person is correct.
d. Differing values are reflected in the two statements.

Answer 18

ANS: D
Values guide beliefs and actions. The individuals stating their positions place different values on life and autonomy. Nurses must be aware of their own values and be sensitive to the values of others.

Question 19

Which issues should a nurse address during the first interview with a patient with a psychiatric disorder?

a. Trust, congruence, attitudes, and boundaries
b. Goals, resistance, unconscious motivations, and diversion
c. Relationship parameters, the contract, confidentiality, and termination
d. Transference, countertransference, intimacy, and developing resources

Answer 19

ANS: C
Relationship parameters, the contract, confidentiality, and termination are issues that should be considered during the orientation phase of the relationship. The remaining options are issues that are dealt with later.

Question 20

An advanced practice nurse observes a novice nurse expressing irritability regarding a patient with a long history of alcoholism and suspects the new nurse is experiencing countertransference. Which comment by the new nurse confirms this suspicion?

a. “This patient continues to deny problems resulting from drinking.”
b. “My parents were alcoholics and often neglected our family.”
c. “The patient cannot identify any goals for improvement.”
d. “The patient said I have many traits like her mother.”

Answer 20

ANS: B
Countertransference occurs when the nurse unconsciously and inappropriately displaces onto the patient feelings and behaviors related to significant figures in the nurse’s past. In this instance, the new nurse’s irritability stems from relationships with parents. The distracters indicate transference or accurate analysis of the patient’s behavior.

Question 21

Which behavior shows that a nurse values autonomy? The nurse

a. suggests one-on-one supervision for a patient who has suicidal thoughts.
b. informs a patient that the spouse will not be in during visiting hours.
c. discusses options and helps the patient weigh the consequences.
d. sets limits on a patient’s romantic overtures toward the nurse.

Answer 21

ANS: C
A high level of valuing is acting on one’s belief. Autonomy is supported when the nurse helps a patient weigh alternatives and their consequences before the patient makes a decision. Autonomy or self-determination is not the issue in any of the other behaviors.

Question 22

As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurse’s best action?
a. Recognize the effectiveness of the relationship and patient’s thoughtfulness.
Accept the card.
b. Inform the patient that accepting gifts violates policies of the facility. Decline the
card.
c. Acknowledge the patient’s transition through the termination phase but decline the
card.
d. Accept the card and invite the patient to return to participate in other arts and crafts groups.

Answer 22

ANS: A
The nurse must consider the meaning, timing, and value of the gift. In this instance, the nurse should accept the patient’s expression of gratitude. See relationship to audience response question.

Question 23

A patient says, “I’m still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?” What is the nurse’s best response?

a. “Why are you asking me when you’re able to speak for yourself?”
b. “I will be glad to address it when I see your doctor later today.”
c. “That’s a good topic for you to discuss with your doctor.”
d. “Do you think you can’t speak to a doctor?”

Answer 23

ANS: C
Nurses should encourage patients to work at their optimal level of functioning, which in turn promotes autonomy. A nurse does not act for the patient unless it is necessary. Acting for a patient increases feelings of helplessness and dependency.

Question 24

A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship?

a. Begin at the orientation phase.
b. Resume the working relationship.
c. Initially establish a social relationship.
d. Return to the emotional catharsis phase.

Answer 24

ANS: A
After termination of a long-term relationship, the patient and new nurse usually have to begin at ground zero, the orientation phase, to build a new relationship. If termination is successfully completed, the orientation phase sometimes progresses quickly to the working phase. Other times, even after successful termination, the orientation phase may be prolonged.

Question 25

As a patient diagnosed with a mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario?

a. The invitation facilitates dependency on the nurse.
b. The nurse’s action blurs the boundaries of the therapeutic relationship.
c. The invitation is therapeutic for the patient’s diversional activity deficit. d. The nurse’s action assists the patient’s integration into community living.

Answer 25

ANS: B

The invitation creates a social relationship rather than a therapeutic relationship.

Question 26

A nurse says, “I am the only one who truly understands this patient. Other staff members are too critical.” The nurse’s statement indicates

a. boundary blurring.
b. sexual harassment.
c. positive regard.
d. advocacy.

Answer 26

ANS: A
When the role of the nurse and the role of the patient shift, boundary blurring may arise. In this situation the nurse is becoming overinvolved with the patient as a probable result of unrecognized countertransference. When boundary issues occur, the need for supervision exists. The situation does not describe sexual harassment. Data are not present to suggest positive regard or advocacy.

Question 27

Which comment best indicates that a patient perceived the nurse was caring? “My nurse
a. always asks me which type of juice I want to help me swallow my medication.”
b. explained my treatment plan to me and asked for my ideas about how to make it
better.”
c. spends time listening to me talk about my problems. That helps me feel like I am
not alone.”
d. told me that if I take all the medicines the doctor prescribes, then I will get
discharged sooner.”

Answer 27

ANS: C
Caring evidences empathetic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The distracters give examples of statements that demonstrate advocacy or giving advice.

Question 28

A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? (Select all that apply.)

a. Focus dialogues with the patient on problems that may occur in the future.
b. Help the patient express feelings about the relationship with the nurse.
c. Help the patient prioritize and modify socially unacceptable behaviors.
d. Reinforce expectations regarding the parameters of the relationship.
e. Help the patient to identify strengths, limitations, and problems.

Answer 28

ANS: A, B
The correct actions are part of the termination phase. The other actions would be used in the working and orientation phases.

Question 29

A novice psychiatric nurse has a parent diagnosed with bipolar disorder. This nurse angrily recalls feelings of embarrassment about the parent’s behavior in the community. Select the best ways for this nurse to cope with these feelings. (Select all that apply.)
a. Seek ways to use the understanding gained from childhood to help patients cope
with their own illnesses.
b. Recognize that these feelings are unhealthy. The nurse should try to suppress them
when working with patients.
c. Recognize that psychiatric nursing is not an appropriate career choice. Explore
other nursing specialties.
d. The nurse should begin new patient relationships by saying, “My own parent had
mental illness, so I accept it without stigma.”
e. Recognize that the feelings may add sensitivity to the nurse’s practice, but
supervision is important.

Answer 29

ANS: A, E
The nurse needs support to explore these feelings. An experienced psychiatric nurse is a resource that may be helpful. The knowledge and experience gained from the nurse’s relationship with a mentally ill parent may contribute sensitivity to compassionate practice. Self-disclosure and suppression are not adaptive coping strategies. The nurse should not give up on this area of practice without first seeking ways to cope with the memories.

Question 30

A novice nurse tells a mentor, “I want to convey to my patients that I am interested in them and that I want to listen to what they have to say.” Which behaviors will be helpful in meeting the nurse’s goal? (Select all that apply.)

a. Sitting behind a desk, facing the patient
b. Introducing self to a patient and identifying own role
c. Maintaining control of discussions by asking direct questions
d. Using facial expressions to convey interest and encouragement
e. Assuming an open body posture and sometimes mirror imaging

Answer 30

ANS: B, D, E
Trust is fostered when the nurse gives an introduction and identifies his or her role. Facial expressions that convey interest and encouragement support the nurse’s verbal statements to that effect and strengthen the message. An open body posture conveys openness to listening to what the patient has to say. Mirror imaging enhances patient comfort. A desk would place a physical barrier between the nurse and patient. A face-to-face stance should be avoided when possible and a less intense 90- or 120-degree angle used to permit either party to look away without discomfort.

Question 31

A patient says to the nurse, “I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which response should the nurse use to clarify the patient’s comment?

a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
c. “So you feel as though you did not get enough quality sleep last night?”
d. “Can you give me an example of what you mean by ‘stoned’?”

Answer 31

ANS: D
The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient’s statement. Asking for a definition of “stoned” directly asks for clarification. Restating that the patient is uncomfortable with the dream’s content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient’s comment.

Question 32

A patient diagnosed with schizophrenia tells the nurse, “The Central Intelligence Agency is monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful what you say.” Which response by the nurse is most therapeutic?

a. “Let’s talk about something other than the CIA.”
b. “It sounds like you’re concerned about your privacy.”
c. “The CIA is prohibited from operating in health care facilities.”
d. “You have lost touch with reality, which is a symptom of your illness.”

Answer 32

ANS: B
It is important not to challenge the patient’s beliefs, even if they are unrealistic. Challenging undermines the patient’s trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient’s message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful, but uncompassionate.

Question 33

The patient says, “My marriage is just great. My spouse and I always agree.” The nurse observes the patient’s foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient’s communication is

a. clear.
b. distorted.
c. incongruous.
d. inadequate.

Answer 33

ANS: B
The patient’s verbal and nonverbal communication in this scenario are incongruous. Incongruous messages involve transmission of conflicting messages by the speaker. The patient’s verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

Question 34

A nurse interacts with a newly hospitalized patient. Select the nurse’s comment that applies the communication technique of “offering self.”
a. “I’ve also had traumatic life experiences. Maybe it would help if I told you about
them.”
b. “Why do you think you had so much difficulty adjusting to this change in your
life?”
c. “I hope you will feel better after getting accustomed to how this unit operates.”
d. “I’d like to sit with you for a while to help you get comfortable talking to me.”

Answer 34

ANS: D
“Offering self” is a technique that should be used in the orientation phase of the
nurse–patient relationship. Sitting with the patient, an example of “offering self,” helps to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but is an example of “offering hope.”

Question 35

Which technique will best communicate to a patient that the nurse is interested in listening?

a. Restating a feeling or thought the patient has expressed.
b. Asking a direct question, such as “Did you feel angry?”
c. Making a judgment about the patient’s problem.
d. Saying, “I understand what you’re saying.”

Answer 35

ANS: A
Restating allows the patient to validate the nurse’s understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse–patient relationship. Close-ended questions such as “Did you feel angry?” ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient’s words, the patient has no way of measuring the understanding.

Question 36

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

a. “What are the common elements here?”
b. “Tell me again about your experiences.”
c. “Am I correct in understanding that.”
d. “Tell me everything from the beginning.”

Answer 36

ANS: C
Asking, “Am I correct in understanding that …” permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.

Question 37

A patient tells the nurse, “I don’t think I’ll ever get out of here.” Select the nurse’s most therapeutic response.

a. “Don’t talk that way. Of course you will leave here!”
b. “Keep up the good work, and you certainly will.”
c. “You don’t think you’re making progress?”
d. “Everyone feels that way sometimes.”

Answer 37

ANS: C
By asking if the patient does not believe that progress has been made, the nurse is reflecting or paraphrasing by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to “talk that way” is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

Question 38

Documentation in a patient’s chart shows, “Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, ‘I enjoy spending time with you.’” Which analysis is most accurate?
a. The patient is giving positive feedback about the nurse’s communication
techniques.
b. The nurse is viewing the patient’s behavior through a cultural filter.
c. The patient’s verbal and nonverbal messages are incongruent.
d. The patient is demonstrating psychotic behaviors.

Answer 38

ANS: C
When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. It is inaccurate to say that the patient is giving positive feedback about the nurse’s communication techniques. The concept of a cultural filter is not relevant to the situation because a cultural filter determines what we will pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

Question 39

While talking with a patient diagnosed with major depressive disorder, a nurse notices thepatient is unable to maintain eye contact. The patient’s chin lowers to the chest. The patient looks at the floor. Which aspect of communication has the nurse assessed?

a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills

Answer 39

ANS: A
Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient’s social skills or an existing cultural barrier.

Question 40

During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient’s hand. Select the correct analysis of the nurse’s behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to
express feelings.
b. The gesture is premature. The patient’s cultural and individual interpretation of
touch is unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Psychiatric patients should not be touched.

Answer 40

ANS: B
Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment is completed regarding the way in which the patient will perceive touch. The incorrect options present prematurely drawn conclusions.

Question 41

During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication.

a. “I notice you keep looking toward the door.”
b. “This is our time together. No one is going to interrupt us.”
c. “It looks as if you are eager to end our discussion for today.”
d. “If you are uncomfortable in this room, we can move someplace else.”

Answer 41

ANS: A
Making observations and encouraging the patient to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.

Question 42

A black patient says to a white nurse, “There’s no sense talking about how I feel. You wouldn’t understand because you live in a white world.” The nurse’s best action would be to

a. explain, “Yes, I do understand. Everyone goes through the same experiences.”
b. say, “Please give an example of something you think I wouldn’t understand.”
c. reassure the patient that nurses interact with people from all cultures.
d. change the subject to one that is less emotionally disturbing.

Answer 42

ANS: B
Having the patient speak in specifics rather than globally will help the nurse understand the patient’s perspective. This approach will help the nurse engage the patient. Reassurance and changing the subject are not therapeutic techniques.

Question 43

A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient’s self-esteem but after 3 weeks, the patient’s eye contact did not improve. What is the most accurate analysis of this scenario?

a. The patient’s eye contact should have been directly addressed by role playing to increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.
c. The patient’s poor eye contact is indicative of anger and hostility that were unaddressed.
d. The nurse should have assessed the patient’s culture before making this diagnosis and plan.

Answer 43

ANS: D
The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

Question 44

When a female Mexican American patient and a female nurse sit together, the patient often holds the nurse’s hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior. Which analysis is most accurate?
a. The patient is accustomed to touch during conversation, as are members of many
Hispanic subcultures.
b. The patient understands that touch makes the nurse uncomfortable and controls the
relationship based on that factor.
c. The patient is afraid of being alone. When touching the nurse, the patient is
reassured and comforted.
d. The patient is trying to manipulate the nurse using nonverbal techniques.

Answer 44

ANS: A
The most likely answer is that the patient’s behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.

Question 45

A Puerto Rican American patient uses dramatic body language when describing emotional

discomfort. Which analysis most likely explains the patient’s behavior? The patient
a. has a histrionic personality disorder.
b. believes dramatic body language is sexually appealing.
c. wishes to impress staff with the degree of emotional pain.
d. belongs to a culture in which dramatic body language is the norm.

Answer 45

ANS: D
Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

Question 46

During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying:

a. “Why do you keep asking about me?”
b. “Nurses direct the interviews with patients.”
c. “Do not ask questions about my personal life.”
d. “The time we spend together is to discuss your concerns.”

Answer 46

ANS: D
When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse’s personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. “Why” questions are probing and nontherapeutic.

Question 47

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

a. A nurse is responsible for breaking silences.
b. Patients withdraw if silences are prolonged.
c. Silence can provide meaningful moments for reflection.
d. Silence helps patients know that what they said was understood.

Answer 47

ANS: C
Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.

Question 48

A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice

a. is rarely helpful.
b. fosters independence.
c. lifts the burden of personal decision making.
d. helps the patient develop feelings of personal adequacy.

Answer 48

ANS: A
Giving advice fosters dependence on the nurse and interferes with a patient’s right to make personal decisions. It robs the patient of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it may contribute to a patient’s feelings of personal inadequacy. Giving advice also keeps the nurse in control and feeling powerful.

Question 49

A school age child tells the school nurse, “Other kids call me mean names and will not sit with me at lunch. Nobody likes me.” Select the nurse’s most therapeutic response.

a. “Just ignore them and they will leave you alone.”
b. “You should make friends with other children.”
c. “Call them names if they do that to you.”
d. “Tell me more about how you feel.”

Answer 49

ANS: D

The correct response uses exploring, a therapeutic technique. The distracters give advice, a nontherapeutic technique.

Question 50

A patient with acute depression states, “God is punishing me for my past sins.” What is the nurse’s most therapeutic response?

a. “You sound very upset about this.”
b. “God always forgives us for our sins.”
c. “Why do you think you are being punished?”
d. “If you feel this way, you should talk to your minister.”

Answer 50

ANS: A
The nurse reflects the patient’s comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are nontherapeutic.

Question 51

A patient cries as the nurse explores the patient’s feelings about the death of a close friend. The patient sobs, “I shouldn’t be crying like this. It happened a long time ago.” Which responses by the nurse facilitate communication? (Select all that apply.)

a. “Why do you think you are so upset?”
b. “I can see that you feel sad about this situation.”
c. “The loss of a close friend is very painful for you.”
d. “Crying is a way of expressing the hurt you are experiencing.”
e. “Let’s talk about something else because this subject is upsetting you.”

Answer 51

ANS: B, C, D
Reflecting (“I can see that you feel sad,” “This is very painful for you”) and giving information (“Crying is a way of expressing hurt”) are therapeutic techniques. “Why” questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

Question 52

Which benefits are most associated with use of telehealth technologies? (Select all that apply.)

a. Cost savings for patients
b. Maximize care management
c. Access to services for patients in rural areas
d. Prompt reimbursement by third-party payers
e. Rapid development of trusting relationships with patients

Answer 52

ANS: A, B, C
Telehealth has shown that it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services; telehealth technologies can solve those problems. Although telehealth’s improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third-party payers. Telehealth technologies have not shown rapid development of trusting relationships.

Question 53

Which comments by a nurse demonstrate use of therapeutic communication techniques? (Select all that apply.)

a. “Why do you think these events have happened to you?”
b. “There are people with problems much worse than yours.”
c. “I’m glad you were able to tell me how you felt about your loss.”
d. “I noticed your hands trembling when you told me about your accident.”
e. “You look very nice today. I’m proud you took more time with your appearance.”

Answer 53

ANS: C, D
The correct responses demonstrate use of the therapeutic techniques making an observation
and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are nontherapeutic techniques.

Question 54

A nurse interacts with patients diagnosed with various mental illnesses. Which statements reflect use of therapeutic communication? (Select all that apply.)

a. “Tell me more about that situation.”
b. “Let’s talk about something else.”
c. “I notice you are pacing a lot.”
d. “I’ll stay with you a while.”
e. “Why did you do that?”

Answer 54

ANS: A, C, D
The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate changing the subject and probing, which are nontherapeutic techniques.

Question 55

The adult child of a patient diagnosed with major depressive disorder asks, “Do you think depression and physical illness are connected? Since my father’s death, my mother has had shingles and the flu, but she’s usually not one who gets sick.” Which answer by the nurse best reflects current knowledge?

a. “It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system.”
b. “You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses.”
c. “So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link.”
d. “Negative emotions and prolonged stress interfere with the body’s ability to protect itself and can increase the likelihood of illness.”

Answer 55

ANS: D
The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to illness.
Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother’s baseline.

Question 56

A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize?

a. Engaging in activity without using any supplemental oxygen
b. Sleeping comfortably and soundly, without respiratory distress
c. Feeling relaxed and taking regular deep breaths when leaving home
d. Having a younger, healthier body that knows no exercise limitations

Answer 56

ANS: C
The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen–carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life.

Question 57

A nurse leads a psychoeducational group for patients experiencing depression. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise

a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors.
b. prevents damage from overstimulation of the sympathetic nervous system.
c. detoxifies the body by removing metabolic wastes and other toxins.
d. improves mood stability for patients with bipolar disorders.

Answer 57

ANS: A

• Endorphins produced during exercise result in improvement in mood and lowered
  anxiety. The other options are not accurate.

Question 58

A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, “The immigration to America has been very difficult.” Considering cultural background, which expression of stress by this patient would the nurse expect?

a. Motor restlessness
b. Somatic complaints
c. Memory deficiencies
d. Sensory perceptual alterations

Answer 58

ANS: B
Honduras is in Central America. Many people from Central American cultures express distress in somatic terms. The other options are not specific to this patient’s cultural background and are less likely to be observed in persons from Central America.

Question 59

A patient nervously says, “Financial problems are stressing my marriage. I’ve heard rumors about cutbacks at work; I am afraid I might get laid off.” The patient’s pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement?

a. Advise the patient, “Go to sleep 30 to 60 minutes earlier each night to increase rest.”
b. Direct the patient in slow and deep breathing using abdominal muscles.
c. Suggest the patient consider that a new job might be better than the present one.
d. Tell the patient, “Relax by spending more time playing with your pet.”

Answer 59

ANS: B
The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident by elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system will counter the sympathetic nervous system’s arousal, normalizing these vital sign changes and reducing the physiological demands stress is placing on his body. Other options do not address his physiological response pattern as directly or immediately.

Question 60

According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a person’s stress status and coping abilities?

a. A person who has been assigned more responsibility at work
b. A parent whose job required relocation to a different city
c. A person returning to college after an employer ceased operations
d. A man who recently separated from his wife because of marital problems

Answer 60

ANS: C
A person returning to college after losing a job is dealing with two significant stressors
simultaneously. Together, these stressors total more life change units than any of the single
stressors cited in the other options.

Question 61

A patient newly diagnosed as HIV-positive seeks the nurse’s advice on how to reduce the risk of infections. The patient says, “I went to church years ago and I was in my best health then. Maybe I should start going to church again.” Which response will the nurse offer?

a. “Religion does not usually affect health, but you were younger and stronger then.”
b. “Contact with supportive people at a church might help, but religion itself is not especially helpful.”
c. “Studies show that spiritual practices can enhance immune system function and coping abilities.”
d. “Going to church would expose you to many potential infections. Let’s think about some other options.”

Answer 61

ANS: C
Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being. The other options wrongly suggest that spiritual practices have little effect on the immune system or reject the patient’s preferences regarding health management.

Question 62

When a nurse asks a newly admitted patient to describe social supports, the patient says, “My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I don’t have many friends because most people my age just want to go out drinking.” Which action will the nurse apply?

a. Advise the patient that being so particular about potential friends reduces social contact.
b. Suggest using the Internet as a way to find supportive others with similar values.
c. Encourage the patient to begin dating again, perhaps with members of the church.
d. Discuss how divorce support groups could increase coping and social support.

Answer 62

ANS: D
High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships affect a person’s coping negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than helping her cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable persons.

Question 63

A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse, “Do you think saying a prayer would help?” Select the nurse’s best answer.

a. “It could be that prayer is your only hope.”
b. “You may find prayer gives comfort and lowers your stress.”
c. “I can help you feel calmer by teaching you meditation exercises.”
d. “We do not have evidence that prayer helps, but it wouldn’t hurt.”

Answer 63

ANS: B
Many patients find that spiritual measures, including prayer, are helpful in mediating stress. Studies have shown that spiritual practices can enhance the sense of well-being. When a patient suggests a viable means of reducing stress, it should be supported by the nurse. Indicating that prayer is the patient’s only hope is pessimistic and would cause further distress. Suggesting meditation or other alternatives to prayer implies that the nurse does not think prayer would be effective.

Question 64

A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient’s vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected?

a. P 64, R 14
b. P 68, R 12
c. P 72, R 16
d. P 80, R 20

Answer 64

ANS: D
The patient would experience stress associated with anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight or flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs.

Question 65

A patient tells the nurse, “I know that I should reduce the stress in my life, but I have no idea where to start.” What would be the best initial nursing response?

a. “Physical exercise works to elevate mood and reduce anxiety.”
b. “Reading about stress and how to manage it might be a good place to start.”
c. “Why not start by learning to meditate? That technique will cover everything.”
d. “Let’s talk about what is going on in your life and then look at possible options.”

Answer 65

ANS: D
In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. Further assessment is indicated before potential solutions can be explored. Suggesting exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.

Question 66

A patient tells the nurse, “My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking.” Which response by the nurse would support the recommendation?

a. Encourage the patient to imagine being in calm circumstances.
b. Provide the patient with a blank journal and guidance about journaling.
c. Teach the patient to recognize, reconsider, and reframe irrational thoughts.
d. Teach the patient to use instruments that give feedback about bodily functions.

Answer 66

ANS: C
Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient’s manner of thinking.

Question 67

A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress?
a. The patient’s systolic blood pressure has changed from the 140s to the 120s mm
Hg.
b. The patient reports, “I feel better, and that things are not bothering me as much.”
c. The patient reports, “I spend more time napping or sitting quietly at home.”
d. The patient’s weight decreased by 3 pounds.

Answer 67

ANS: A
Objective measures tend to be the most reliable means of gauging progress. In this case, the patient’s elevated blood pressure, an indication of the body’s physiological response to stress, has diminished. The patient’s report regarding activity level is subjective; sitting quietly could reflect depression rather than improvement. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress. The patient’s weight change could be a positive or negative indicator; the blood pressure change is the best answer.

Question 68

A patient tells the nurse, “I will never be happy until I’m as successful as my older sister.” The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping?

a. “People should treat me as well as they treat my sister.”
b. “I can find contentment in succeeding at my own job level.”
c. “I won’t be happy until I make as much money as my sister.”
d. “Being as smart or clever as my sister isn’t really important.”

Answer 68

ANS: B
Finding contentment within one’s own work, even when it does not involve success as others might define it, is likely to lead to a reduced sense of distress about achievement level. It speaks to finding satisfaction and happiness without measuring the self against another person. Focusing on salary is simply a more specific way of being as successful as the sister, which would not promote coping. Expecting others to treat her as they do her sister is beyond her control. Dismissing the sister’s cleverness as unimportant indicates that the patient continues to feel inferior to the sibling.

Question 69

A patient says, “One result of my chronic stress is that I feel so tired. I usually sleep from 11:00 PM to 6:30 AM. I started setting my alarm to give me an extra 30 minutes of sleep each morning, but I don’t feel any better and I’m rushed for work.” Which nursing response would best address the patient’s concerns?

a. “You may need to speak to your doctor about taking a sedative to help you sleep.”
b. “Perhaps going to bed a half-hour earlier would work better than sleeping later.”
c. “A glass of wine in the evening might take the edge off and help you to rest.”
d. “Exercising just before retiring for the night may help you to sleep better.”

Answer 69

ANS: B
Sleeping later in the morning may disturb circadian rhythms and in this case is adding, rather than reducing, stress. Going to bed earlier and arising at the usual time alleviates fatigue more effectively. Sedatives may offer some benefit but are a short-term intervention with potential side effects, and other nonpharmacological interventions might work as well or better. Exercise earlier in the evening could induce tiredness and ease the process of falling asleep, but doing so right before bedtime would stimulate and interfere with sleep. Alcohol is sedating but potentially addictive; encouraging its use could increase the risk of using alcohol maladaptively as a response to stress in general.

Question 70

A patient reports, “I am overwhelmed by stress.” Which question by the nurse would be
most important to use in the initial assessment of this patient?
a. “Tell me about your family history. Do you have any relatives who have problems
with stress?”
b. “Tell me about your exercise. How much activity do you typically get in a day?”
c. “Tell me about the kinds of things you do to reduce or cope with your stress.”
d. “Stress can interfere with sleep. How much did you sleep last night?”

Answer 70

ANS: C
The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether or not his distress is placing him in danger (e.g., by elevating his blood pressure dangerously or via maladaptive responses, such as drinking) and would help the nurse understand how he copes and how well his coping strategies and resources serve him. Of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful but seek data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general).

Question 71

Which scenario best demonstrates an example of eustress? An individual
a. loses a beloved family pet.
b. prepares to take a vacation to a tropical island with a group of close friends.
c. receives a bank notice that there were insufficient funds in his/her account for a
recent rent payment.
d. receives notification that his/her current employer is experiencing financial
problems and some workers will be terminated.

Answer 71

ANS: B
Eustress is beneficial stress; it motivates people to develop skills they need to solve problems and meet personal goals. Positive life experiences produce eustress. Going on a tropical vacation is an exciting, relaxing experience and is an example of eustress. Losing the family pet, worrying about employment security, and having financial problems are examples of distress, a negative experience that drains energy and can lead to significant emotional problems. See related audience response question.

Question 72

A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system?

a. Thalamus
b. Parietal lobe
c. Hypothalamus
d. Pituitary gland

Answer 72

ANS: C
The individual will find this experience stressful. The hypothalamus functions as the
command-and-control center when receiving stressful signals. The hypothalamus responds to signals of stress by engaging the autonomic nervous system. The parietal lobe is responsible for interpretation of other sensations. The thalamus processes messages associated with pain and wakefulness. The pituitary gland may be involved in other aspects of the person’s response but would not stimulate the autonomic nervous system.

Question 73

A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience?

a. Limbic system
b. Peripheral nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system

Answer 73

ANS: C
The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system.

Question 74

Which changes reflect short-term physiological responses to stress? (Select all that apply.)

a. Muscular tension, blood pressure, and triglycerides increase.
b. Epinephrine is released, increasing heart and respiratory rates.
c. Corticosteroid release increases stamina and impedes digestion.
d. Cortisol is released, increasing glucogenesis and reducing fluid loss.
e. Immune system functioning decreases, and risk of cancer increases.
f. Risk of depression, autoimmune disorders, and heart disease increases.

Answer 74

ANS: A, B, C, D
The correct answers are all short-term physiological responses to stress. Increased risk of immune system dysfunction, cancer, cardiovascular disease, depression, and autoimmune disease are all long-term (chronic) effects of stress.

Question 75

Which comments by a nurse are likely to help a patient cope by addressing the mediators of the stress response? (Select all that apply.)
a. “A divorce, while stressful, can be the beginning of a new, better phase of life.”
b. “You mentioned your spirituality. Are there aspects of your faith that could be
helpful to you at this time?”
c. “Journaling often promotes awareness of how experiences have affected people.”
d. “It seems to me you are overreacting to this change in your life.”
e. “There is a support group for newly divorced persons in your neighborhood.”

Answer 75

ANS: A, B, C, E
Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how we perceive and respond to stress (or how our personality affects how we respond to stressors). A loan could help the patient by reducing the financial pressures. Participation in support groups is an excellent way to expand one’s support network relative to specific issues. Many persons derive comfort and support from participation in faith-based interventions. The incorrect response demonstrates judging, which is non-therapeutic communication by the nurse and would not facilitate coping.

Question 76

The nurse wishes to use guided imagery to help a patient relax. Which comments would be appropriate to include in the guided imagery script? (Select all that apply.)
a. “Imagine others treating you the way they should, the way you want to be treated
…”
b. “With each breath, you feel calmer, more relaxed, almost as if you are floating …”
c. “You are alone on a beach, the sun is warm, and you hear only the sound of the
surf …”
d. “You have taken control, nothing can hurt you now. Everything is going your way
…”
e. “You have grown calm, your mind is still, there is nothing to disturb your
well-being …”
f. “You will feel better as work calms down, as your boss becomes more
understanding …”

Answer 76

ANS: B, C, E
The intent of guided imagery to assist patients manage stress is to lead the patient to envision images that are calming and health-enhancing. Statements that involve the patient calming progressively with breathing, feeling increasingly relaxed, being in a calm and pleasant location, being away from stressors, and having a peaceful and calm mind are therapeutic and should be included in the script. However, items that raise stressful images or memories or that involve unrealistic expectations or elements beyond the patient’s control (e.g., that others will treat the patient as he desires, that everything is going the patient’s way, that bosses are understanding) interfere with relaxation and/or do not promote effective coping. Thus these are not health-promoting and should not be included in the script.

Question 77

An individual says to the nurse, “I feel so stressed out lately. I think the stress is affecting my body also.” Which somatic complaints are most likely to accompany this feeling? (Select all that apply.)

a. Headache
b. Neck pain
c. Insomnia
d. Anorexia
e. Myopia

Answer 77

ANS: A, B, C, D
When individuals feel “stressed-out,” they often have accompanying somatic complaints, especially associated with sleep, eating, and headache or back pain. Changes in vision, such as myopia, would not be expected.

Question 78

Which action shows the cyclical phase of forming?
a.
A group dissolving
b.
Individuals coming together with a common bond
c.
Developing mutual goals
d.
A group completing tasks together

Answer 78

ANS: B
Forming is the beginning development of a group with well-defined reasons and common directions. Adjourning is the phase where groups dissolve. Norming is the phase in which mutual goals are established. Completing tasks together is part of the performing phase.

Question 79

The clinical instructor interprets the development of mutual goals and guidelines as
a.
norming.
b.
performing.
c.
storming.
d.
informing.

Answer 79

ANS: A
Norming begins with the development of guidelines and mutual goals. Successful task completion helps to redefine individual behavioral roles in the group. In the performing phase, everyone knows each other, and the group makes changes in a seamless way. The storming phase involves acting out roles normally portrayed in the presence of peers. Informing is not a phase in the group process.

Question 80

A member of a nursing committee frequently disregards the rules of the group and feels that the rules do not apply to the member personally. The president of the committee recognizes this person as a
a.
critical conservative.
b.
motor mouth.
c.
self-server.
d.
mouse.

Answer 80

ANS: C
Self-servers are not willing to serve as a functioning part of the group, although they may appear to be group members when they perceive a personal benefit by the interaction. The critical conservatives typically have criticism for any suggestion other than their own. Motor mouths often interrupt others to get their points across. The mouse is known as a silent observer.

Question 81

Which term refers to the group member who watches others take the risks and responsibility for group input and agrees with everyone in the group?
a.
Mouse
b.
Motor mouth
c.
Self-server
d.
Know-it-all

Answer 81

ANS: A
The mouse is less confident of his or her abilities and is therefore less aggressive in the group dynamics. The motor mouth often interrupts others to get his or her point across. The self-server does not serve as a functional part of the group unless there is a benefit to him/her. The know-it-all is not a term used to describe group members.

Question 82

The dean of the nursing school wants to integrate interprofessional teamwork into the curriculum. What action by the dean would best meet this goal?
a.
Ensure faculty are teaching components of interprofessional practice.
b.
Deliver lectures to the students on interprofessional team dynamics.
c.
Work with the other professional deans on interprofessional simulations.
d.
Organize a workshop on delivering interprofessional health care.

Answer 82

ANS: C
Interprofessional practice involves people from different disciplines working together to provide care to patients. While all options are reasonable choices, simulation provides a hands-on opportunity to work with others and to practice skills, including communication. This would provide the best opportunity to meet the dean’s goals.

Question 83

The nursing manager on the cardiothoracic unit has noted increased friction among the nursing staff and physicians and is contemplating taking action to address the problem. What consideration is important when planning a response?
a.
An emotional bond among team members is important for successful teamwork.
b.
Strong leadership will create an environment where team members must work together.
c.
Professionals need to be clear about disciplinary boundaries and expectations.
d.
Nursing care should be determined solely by the nursing staff and evidence-based guidelines.

Answer 83

ANS: A
One of the most important ingredients in the team approach to delivering patient-centered care is a positive psychological and emotional bond among members of the team, which helps to develop more cohesiveness among the individuals of the team. Without a positive cohesive bond, there can and will be limits to the overall quality and function of the team. Providing activities that strengthen these bonds has the best chance of improving the situation. Strong leadership is important, but you cannot force team members to work well together. Interdisciplinary care is about erasing the strict separations among members of the interdisciplinary team and working together. Nursing care should be determined by evidence-based guidelines, but this doesn’t address the situation.

Question 84

How can the grapevine best be controlled?
a.
Providing factual information in anticipation of employees’ questions
b.
Using an authoritarian communication style
c.
Putting everything in writing
d.
Having a strong union to represent employees

Answer 84

ANS: A
Providing factual information in anticipation of employees’ questions is an effective way to reduce the grapevine. Most employees get secondhand information, and few employees get enough of the factual information that they need. Even if information is put in writing, it is important to communicate verbally to employees by answering their questions. A strong union does not necessarily reduce the grapevine.

Question 85

The graduate nurse has an adequate understanding of effective listening when stating which of the following?
a.
“Limited level of vocabulary often affects listening skills.”
b.
“Underdeveloped attention span affects listening skills.”
c.
“External noise distractions affect listening skills.”
d.
“Emotional reactions interfere with the actual message.”

Answer 85

ANS: D
One of the most problematic reasons for ineffective listening is that people allow their emotions to dictate what they hear or do not hear. Limited vocabulary, underdeveloped attention span, and external noise distractions are not the most problematic reasons for ineffective listening.

Question 86

Which of the following actions by the nurse leader is most likely to lead to an effective meeting?
a.
Creating an atmosphere in which people say very little
b.
Sending out an agenda ahead of time
c.
Creating well-designed overhead transparencies
d.
Completing all the tasks of the group

Answer 86

ANS: B
It is the leader’s responsibility to send out an agenda ahead of time and to indicate any preparations members need to make or materials they need to bring. It is important to have a meeting atmosphere where people feel as though they can respond and ask questions in a cooperative and collaborative setting. It is not necessary to have well-designed handouts for the meeting or for the leader to complete all the tasks of the group because this would indicate a lack of participation from the group members.

Question 87

Which action by the nurse shows a major characteristic of aggressive behavior?
a.
Achievement of personal goals at the expense of others
b.
Indirect expression of personal feelings
c.
Communication of personal needs
d.
Ability to restrict personal rights

Answer 87

ANS: A
All of us have a style of communication that reflects our own personality and self-concept. Achievement of the nurse’s goals at the expense of others shows an aggressive behavior. Indirect expression of one’s feelings describes passive behavior. Being able to communicate one’s own needs describes an assertive behavior. Restricting one’s own rights does not describe an assertive style of communication. Aggression is not an indirect expression of one’s feelings but a very direct expression. Aggressive communication is angry and dominating where the person attempts to humiliate or “put down” other people.

Question 88

The nurse interprets assertive behavior as
a.
apologetic.
b.
coercive.
c.
direct.
d.
self-denying.

Answer 88

ANS: C
A person exhibiting assertive behavior would express his/her true feelings in an honest, direct manner. An assertive person’s behavior respects others and is not coercive or self-denying or self-depreciating in any manner. Assertive persons accept compliments and criticism and are not excessively apologetic but have self-respect for their thoughts and actions.

Question 89

The nurse is using assertive communication skills to express self-rights when stating which of the following?
a.
“I shield others from my anger.”
b.
“I do not compromise.”
c.
“I am avoiding direct confrontation.”
d.
“I am responsible for what I say.”

Answer 89

ANS: D
When you use an assertive communication style, you send the message that you will take responsibility for the consequences of both your words and your actions. Assertive individuals often compromise and may confront people directly about issues. Assertive individuals express anger appropriately rather than shielding others or repressing the feeling. The other statements do not express an assertive communication style.

Question 90

Dr. Jones asks you to give a medication to one of the patients, and you know the patient is allergic to it. When you point this out, Dr. Jones says, “Give the medication or I’ll report this to your supervisor.” What is the best assertive response?
a.
Agree to give the medication and hope no one finds out.
b.
Say, “I won’t give the medication, and I don’t care who you talk to about it.”
c.
Walk away and ignore Dr. Jones.
d.
Say, “Perhaps you and I could talk this over with my supervisor together.”

Answer 90

ANS: D
Expressing to the physician that both of you should discuss the issue with the supervisor is an assertive response. As nurses gain experience, their judgment improves, and they are able to recognize ways to communicate needs and feelings with the goal of improving the processes and procedures used in the work setting. The patient’s safety always comes first, so you would not go ahead and give the medication. When you walk away and ignore the comment, you are denying the feelings and not dealing assertively with the situation. Not giving the medication and stating that you don’t care who the physician talks to about the issue is a threatening, aggressive response.

Question 91

Your team leader reminds you that you have forgotten to complete an assigned task. What is an assertive response?
a.
“Not now; I’m busy.”
b.
“You’re right. I did forget. I’ll do it now.”
c.
“It’s not my fault. You should have reminded me sooner.”
d.
“I’m so sorry I’ve disappointed you. It won’t happen again.”

Answer 91

ANS: B
When using assertive communication, a person would respond to criticism by acknowledging the issue and taking direct action to correct the problem. An apologetic response is not assertively taking responsibility for the forgotten task. Telling the person “you should have reminded me sooner” is placing the responsibility for the forgotten task onto another person. Telling the person you are busy is denying the issue.

Question 92

Staff nurse 1: “You’re stomping around and glaring at me. I’m wondering what’s going on.” Staff nurse 2: “I’m sick of you always going to lunch first. You don’t care about anyone but yourself.” What assessment can best be made about this exchange?
a.
Staff nurse 1’s remark is challenging and obstructive.
b.
Staff nurse 1’s remark invites clarification of the meaning of the specific behaviors of staff nurse 2.
c.
Staff nurse 2’s remark will facilitate effective problem solving.
d.
Staff nurse 2’s remark will keep anger at a minimum and give incentive for meeting the other’s needs.

Answer 92

ANS: B
Nurse 1 was assertive in her approach by giving direct descriptive feedback reflecting nurse 2’s actions with a question seeking information to explain nurse 2’s actions. Asking about what is going on allows nurse 2 to make some comment about the issue. Nurse 2’s comment does not promote effective problem solving as it is judgmental (You don’t care about anyone but yourself.).

Question 93

A nurse is meeting with the nurse supervisor to discuss an issue with a coworker. Which of the following statements would help the nurse effectively communicate with the supervisor?
a.
“This is all my coworker’s fault. I never do anything wrong.”
b.
“My coworker always makes 100 excuses to get out of work.”
c.
“I knew you would be on their side.”
d.
“I feel upset that my coworker seems to have less work than I do.”

Answer 93

ANS: D
When communicating with a nurse supervisor, the nurse should avoid blaming others and exaggeration. The nurse should instead focus on using “I” statements to express the issue.

Question 94

Which statement made the by the nurse indicates understanding of how to control the grapevine?
a.
“Grapevine rumors are generally true.”
b.
“Avoid face-to-face communication.”
c.
“Avoid spreading rumors.”
d.
“Keep rumors circulating.”

Answer 94

ANS: C
To control the grapevine, the nurse should avoid spreading rumors. The nurse should also promote face-to-face communication, obtain information from the source, and stop the circulating of rumors by not engaging in gossip.

Question 95

A nurse is caring for a patient who is an immigrant. The nurse is aware of the importance of cultural competency and providing the patient with culturally competent care. What can be done to enhance communication with this patient?
a.
Use jargon or slang.
b.
Obtain an interpreter if needed.
c.
Give longer explanations to enhance understanding.
d.
Speak loudly to the patient.

Answer 95

ANS: B
To communicate effectively with this patient, the nurse may need to obtain an interpreter. The nurse should also avoid jargon or slang, give shorter explanations, and speak in a normal volume and tone to the patient.

Question 96

A nurse manager is educating staff on how to give effective presentations. Which statement indicates an understanding of this?
a.
“To give an effective presentation, you should always maintain a positive attitude.”
b.
“You should avoid planning and should create the presentation as you go.”
c.
“Give the same presentation regardless of the audience.”
d.
“To reduce anxiety, avoid making eye contact with the audience.”

Answer 96

ANS: A
To give an effective presentation the nurse should always maintain a positive attitude, plan the presentation ahead of time, spice up the presentation and make changes according to the audience, and make eye contact.

Question 97

Which statement would be most appropriate for the nurse to make when practicing assertive behavior?
a.
“I feel upset when Dr. Smith yells at me in front of my patients.”
b.
“I can’t believe what a jerk Dr. Smith is; the doctor should be fired!”
c.
“Dr. Smith was right in her action.”
d.
“I am reporting Dr. Smith to the medical director.”

Answer 97

ANS: A
The nurse practicing assertive behavior would state: “I feel upset when Dr. Smith yells at me in front of my patients.” The statement is direct and uses “I” statements. When the nurse says, “I can’t believe what a jerk Dr. Smith is; the doctor should be fired” and “I am reporting Dr. Smith to the medical director,” the nurse is using aggressive behavior. Statements such as “Dr. Smith was right in her action” indicate passive/avoidant behavior.

Question 98

Which of the following actions can the nurse take to communicate with the supervisor? (Select all that apply.)
a.
Keep the supervisor informed.
b.
Focus on problem solving.
c.
Use “you” statements.
d.
Calm down before speaking.
e.
Choose words wisely.

Answer 98

ANS: A, B, D, E
To communicate openly and effectively with the nursing supervisor, the nurse should keep the supervisor informed, focus on problem solving, use “I” statements, calm down before speaking, and choose words wisely.

Question 99

A nurse manager is delegating a task to another nurse. Which of the following action(s) would help the manager effectively communication with the nurse? (Select all that apply.)
a.
Get the full attention of the nurse.
b.
Ask the nurse to repeat back what he or she heard.
c.
Believe the nurse has understood if there are no questions.
d.
Give clear, simple instructions.
e.
Give instructions while multitasking.

Answer 99

ANS: A, B, D
The nurse manager should first get the full attention of the nurse before the nurse manager begins to communicate with the nurse. The nurse manager should give clear, simple instructions and ask the nurse to repeat back what he or she heard.

Question 100

Which actions can the nurse take to improve personal credibility? (Select all that apply.)
a.
Wear well-fitting clothes.
b.
If female, wear a reasonable amount of make-up.
c.
Be as original with hair design as possible.
d.
Maintain a flattering, neat haircut.
e.
Ensure clothes are clean and neat.

Answer 100

ANS: A, B, D, E
To improve the nurse’s credibility, the nurse should wear clean, neat, well-fitting clothes and a reasonable amount of make-up (if female). The nurse should maintain a flattering, neat haircut. The nurse should reserve extremes of individuality for outside of work.

Question 101

Which of the following statements about listening indicate the nurse’s adequate understanding? (Select all that apply.)
a.
“Listening is the hearing of words.”
b.
“Listening requires most of our communication time.”
c.
“We pay most attention to our listening skills.”
d.
“People remember 1/3 of the messages that they have heard.”
e.
“Listening requires a lot of energy.”

Answer 101

ANS: B, D, E
The nurse has an adequate understanding of listening when the nurse states: “Listening is not just the hearing of words,” “Listening requires most of our communication time,” “We pay least attention to our listening skills,” “People remember 1/3 of the messages that they have heard,” and “Listening requires a lot of energy.”

Question 102

A nurse notices that a coworker has been taking longer lunch breaks. The nurse is frustrated by this and wants to use assertive communicate techniques to effectively handle the situation. Which statement(s) would be the most beneficial? (Select all that apply.)
a.
“I feel frustrated about the length of your breaks because I am really busy with my patient assignment today.”
b.
“You need to stop taking such long lunch breaks while the rest of us pick up your slack!”
c.
“I am willing to compromise so that we can both get the breaks and help that we need.”
d.
“I am having a hard time keeping up with both of our assignments today.”
e.
“You are putting my nursing license in jeopardy.”

Answer 102

ANS: A, C, D
To effectively communicate, the nurse should use “I” statements and compromise with her coworker. Statements that would be the most beneficial include “I feel frustrated about the length of your breaks because I am really busy with my patient assignment today,” “I am willing to compromise so that we can both get the breaks and help that we need,” and “I am having a hard time keeping up with both of our assignments today.”

Question 103

During clinical experience, the student nurse is assigned a patient scheduled to undergo numerous treatments. The student decides it is not possible to complete all the needed treatments in the time scheduled for this clinical day. The student nurse consults with the clinical instructor to
a.
delegate.
b.
prioritize.
c.
procrastinate.
d.
do the easiest treatment first.

Answer 103

ANS: B
Plan your care of a patient who requires multiple treatments or complex nursing care by determining the priority of the patient’s problems or needs so that you can provide care to the patient’s highest priority needs first. Delegation would not be the most logical or appropriate choice as the student is not working over anyone. It is not always wise to do the easiest treatment first because difficult treatments may have unexpected outcomes that may challenge time management. Procrastination is never a good approach in managing patient care.

Question 104

The instructor has suggested that the student nurse could improve organizational skills and manage time better by scheduling selected nursing activities in the daily assignment. Which activity should be scheduled?
a.
Suctioning the tracheostomy tube of a patient
b.
Administering medications
c.
Assessing patient knowledge of colostomy care
d.
Assisting a patient with personal hygiene

Answer 104

ANS: B
Medications are the most time-sensitive issues in nursing care delivery. Scheduling is predetermined by the physician’s order. Assessment of a patient’s understanding of colostomy care can be done at any time. Personal hygiene needs can be met around non–time-sensitive issues (medications, treatments) in managing the patient care. Suctioning a tracheostomy should be performed when the patient needs it; it is not scheduled.

Question 105

A nurse is assigned to care for five patients. The nurse is concerned about the ability to care for this many patients. The nurse needs to
a.
delegate one of the patients to someone else.
b.
prioritize the needs of the patients and determine the sickest patient.
c.
report this situation to the charge nurse.
d.
do the easiest patients first to allow more time for sicker patients.

Answer 105

ANS: B
It is important to determine the least stable patient when planning care for multiple patients. Plan and complete the care for the patient who requires multiple treatments or complex nursing care. This patient is most likely to experience physiologic problems if the nurse does not address his or her needs. The others are cared for in the priority order determined by their stability and needs. The nurse may need to enlist the help of the charge nurse if he or she is unable to provide care, but that would not be the first action.

Question 106

Which statement by the nurse manager shows understanding of what initiated the development of the team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS)?
a.
“The increased need for health care coverage”
b.
“The need for more qualified nurses”
c.
“A need for improved communication and teamwork”
d.
“The increased cost of health care”

Answer 106

ANS: C
The Department of Defense (DoD) Patient Safety Program, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), developed an evidence-based teamwork system focused on improving communication and teamwork skills in the health care industry to improve patient outcomes. The team was not created to solve health care coverage concerns, search for more qualified nurses, or decrease the cost of health care. The Joint Commission accredits hospitals and health care agencies. The Institute of Medicine provides national advice on issues relating to biomedical science, medicine, and health, and its mission is to serve as adviser to the nation to improve health. The Centers for Medicare is not about patient safety but about medical insurance for people older than the age of 65 years.

Question 107

The nurse manager is updating unit staff on findings by The Joint Commission. Which of the following statements shows an understanding of untoward events in the hospital setting? The primary cause of untoward events is
a.
“unclear, ineffective communication.”
b.
“unclear chain of communication for reporting.”
c.
“ineffective reporting of the untoward event.”
d.
“lack of consistent supervision of nursing staff.”

Answer 107

ANS: A
Ineffective communication was identified as the root cause for nearly 70% of all sentinel events reported. The majority of those untoward events involved communication failure. The other options were not identified as the majority of all sentinel events.

Question 108

The nurse is receiving a phone order from a health care provider. How will the nurse make sure that the provider’s order is received without error?
a.
Advise the health care provider that the order must be written on the chart within the next 24 hours.
b.
Ask the nurse in charge to come to the phone to take the order.
c.
Write the order without using any unclear or unapproved abbreviations.
d.
Repeat the order, write the order verbatim, and read it back to the provider.

Answer 108

ANS: D
Repeat the order, write the order verbatim, and read it back to the provider are the steps recommended to confirm that the order was understood correctly, as well as communicated correctly. The question is in regard to the receiving of the order, not specifically how it is written. The nurse will write the phone order on the chart, and later the health care provider will co-sign the order. The charge nurse does not have to take the phone order; any licensed nurse can take the phone order.

Question 109

The nurse receives report on an assigned group of patients. Which patient would the nurse assess first?
a.
A patient 2 days postoperative who is complaining of pain
b.
An older adult patient reported to have increasing lethargy and confusion
c.
A newly admitted patient with a serum blood urea nitrogen (BUN) of 32 mg/dL
d.
A hypertensive patient complaining of severe mid-sternum pain

Answer 109

ANS: D
The patient with chest pain is at greatest risk of experiencing urgent problems and needs to be evaluated immediately. This does not mean that the nurse will not address the needs of the other patients, but the safety of the hypertensive patient is at risk if the nurse does not see her first.

Question 110

What are critical points to communicate during a shift report or hand-off communication?
a.
Patient name, current physical status, activities that have contributed to current status, problems that have occurred during the shift, nursing care to address problems, and a readback or response
b.
Patient name, room number and date of birth, changes in current orders, provider’s visits, laboratory tests that have been completed, and physical activity of the patient
c.
Patient name, health care provider, diagnosis, review of all current orders, family visits and involvement in care, review of history leading to hospitalization, and current status of the patient
d.
Physician orders for past 24 hours, patient name and date of birth, medical and social history prior to hospitalization, and review of health problems since hospitalization

Answer 110

ANS: A
According to the I-SBAR-R tool—Identification (patient name), Situation (current physical status), Background (activities that contributed to current status), Assessment (problems that occurred during shift), Recommendation (nursing care to address problems), Readback or Response (receiver acknowledges information)—these are critical areas. All of the other options contain items that are not critical to a shift report.

Question 111

The charge nurse is assigning patient care activities to the nursing care team. In supervising the team, what is the most effective activity to determine that the nursing care has been completed satisfactorily?
a.
Have hourly checks with personnel to determine how effectively nursing care is being completed.
b.
Review with personnel at the end of the shift regarding the status of patients and how care was delivered.
c.
Discuss with each person the status of their assigned patients and what type of nursing care each will require.
d.
Schedule routine patient care rounds to evaluate the patients and the nursing care that has been completed.

Answer 111

ANS: A
Supervision entails providing direction, evaluation, and follow-up by the nurse regarding the nursing care assigned. The only way the nurse can determine whether the care has been done satisfactorily is to monitor the task (hourly checks with personnel) and evaluate the patient. Waiting until the end of the shift could lead to problems not being assessed early to prevent complications. Discussing with the health care provider about the patient is a good practice, but determining the outcome of the care is what needs to be evaluated and not just telling them what type of care is required. Scheduling rounds allows the nurse to evaluate the patient; however, communication with the nursing team is important to determine if care is administered satisfactorily.

Question 112

What would be a good assignment for an experienced nursing assistant?
a.
Help teach patients newly diagnosed with diabetes to give themselves injections.
b.
Report on the quality and quantity of urine on a continuous bladder irrigation.
c.
Obtain a clean-catch urine specimen from a patient.
d.
Chart a diet for a patient with an eating disorder

Answer 112

ANS: C
The nursing assistant can be assigned activities that involve standard, unchanging procedures such as helping to obtain a clean-catch urine specimen from a patient. Charting, teaching, and assessing are not assigned to the nursing assistant.

Question 113

The nurse calls a physician to come to the unit to assess a patient. Which of the following is the most effective telephone communication by the nurse?
a.
“This is the 4100 unit troublemaker again. You probably ought to come to the unit to see Mr. Samuels. His condition doesn’t seem right.”
b.
“This is Ann Allen on 4100. I don’t quite know what to think about Mr. Samuels. I think his condition is deteriorating, and I’d like to have you see him.”
c.
“Sorry to bother you. This may not be important, but I’m not completely comfortable with Mr. Samuel’s response to care. His blood pressure has dropped, and his pulse is elevated.”
d.
“This is Sheila Ryan on 4100 calling regarding your patient, Mr. Samuels. His BP has dropped from 130/90 at 8 AM to 100/70 at 10 AM. His pulse has risen from 80 to 100, and he seems restless. He received his 8 AM Cardizem.”

Answer 113

ANS: D
A detailed, objective response is effective when communicating not only in person but also by telephone. Try organizing your conversation in the I-SBAR-R communication format. The other responses are subjective in nature with no descriptive assessment data to provide to the physician.

Question 114

A nurse is working on a busy orthopedic floor and is on the phone with the floor manager when a physician comes up and gives a verbal order for pain medications on an assigned patient. The physician then turns to leave the unit. Which action by the nurse would be the most appropriate?
a.
Write down the order and administer the medication.
b.
Put the nurse manager on hold and ask the physician to write the order.
c.
Ignore the physician and continue the conversation with the nurse manager.
d.
Write down the order and document it as a telephone order.

Answer 114

ANS: B
The most appropriate action would be for the nurse to put the nurse manager on hold and ask the physician to write the order. The Joint Commission states that there is a big difference between verbal and telephone orders. Verbal orders should never be accepted unless there is an emergency or the physician is in a sterile environment because there is too much opportunity for a transcribing error.

Question 115

The nurse is reviewing I-SBAR-R with a coworker at the end of the shift. Which statement indicates that they are discussing the Situation component?
a.
The nurse states the patient’s name using two identifiers.
b.
The nurse states that the patient was hospitalized for a broken tibia and that surgery is scheduled for later today.
c.
The oncoming nurse acknowledges the info that has been received.
d.
The nurse states an opinion on what is happening with the patient.

Answer 115

ANS: B
In the Situation component of I-SBAR-R, the nurse states what is going on with the patient. In this situation, the patient was hospitalized with a broken tibia, and surgery is planned for later today. The Identification component involves stating the patient’s name, the Assessment component involves the nurse discussing what the nurse thinks is happening with the patient, and the Read-Back or Response component involves that the oncoming nurse repeating what the nurse has heard from the nurse who is reporting at the end of the shift.

Question 116

A nurse has received report on assigned patients and is prioritizing their care. Which of the following patients should the nurse assess first?
a.
A female patient who is complaining of a headache
b.
A patient who has just returned from surgery and has saturated his dressing
c.
A patient with a femur fracture who is requesting pain medications
d.
A male patient who needs to use the bathroom

Answer 116

ANS: B
The nurse should assess patients using Maslow’s hierarchy of needs or the ABCD system. In the situation, the patient who has saturated his postoperative dressing should be seen first because an issue with the circulatory system makes the patient a priority over the others. This patient may be hemorrhaging. The patient with the femur fracture requesting pain medication should be seen next, followed by the patient with the headache who will need a more thorough assessment. The nurse can delegate taking the other patient to the bathroom to the unlicensed assistive personnel, assuming the patient is stable enough to do so.

Question 117

A nurse has been assigned the following patients. Which patient is a priority to assess first?
a.
A patient with abdominal pain
b.
A patient who has been NPO all morning and wants to eat
c.
A patient with pneumonia and O2 saturation of 88%
d.
A patient complaining of ear pain

Answer 117

ANS: C
Using Maslow’s hierarchy of needs or the ABCD system, the nurse should see the patient with pneumonia and low O2 saturation first. Issues involving the airway are a priority, and these patients must be seen first. Next, the nurse should see the patient with abdominal pain followed by the patient with ear pain and then the patient who is NPO and wants to eat.

Question 118

The nurse wants to anticipate patient needs in order to increase patient satisfaction and decrease the use of call bells in the assigned section. What actions can be taken to achieve this?
a.
Tell patients to turn on their call bells if they need something.
b.
Perform hourly rounding on each patient.
c.
Check on the patient every 2 to 3 hours.
d.
Check on the patient only when medication needs to be administered.

Answer 118

ANS: B
Performing hourly rounding encourages the nurse to anticipate patients’ needs, thereby increasing patient satisfaction and decreasing call bell usage. Although checking on the patients every 2 to 3 hours is appropriate, it is not the best answer because hourly rounding provides increased patient satisfaction and reduction of call bells. The nurse needs to check more frequently on patients rather than waiting until the he/she sees them when medications are administered.

Question 119

The charge nurse is determining which activities to delegate to the nursing assistant. Which of the following would not be appropriate for the charge nurse to delegate to the nursing assistant?
a.
Changing soiled linen
b.
Taking a blood pressure on someone receiving blood
c.
Removing a urinary catheter
d.
Assessing a patient’s lung sounds

Answer 119

ANS: D
When delegating care, the charge nurse must remember that she cannot delegate nursing judgment. Therefore, in this scenario, the nurse cannot delegate the task of assessing lung sounds. This is a task that must be performed by the nurse. Taking blood pressures, removing a urinary catheter, and changing bed linens are all activities that can be delegated.

Question 120

A nurse is working with a nurse aide to care for a group of patients. Which of the following activities would be inappropriate to delegate to the nurse aide?
a.
Providing discharge instructions to a patient
b.
Refilling water containers
c.
Obtaining a lift to help a patient out of a chair
d.
Feeding a patient who is unable to feed himself

Answer 120

ANS: A
It is the nurse’s responsibility to provide discharge instructions to patients and to assess their understanding of them. This task cannot be delegated to the nursing assistant. Refilling water containers, obtaining a lift to help a patient out of a chair, and feeding patients are all tasks that can be delegated to the nursing assistant.

Question 121

A nurse is working on a medical-surgical unit and receives a phone call from a provider who would like to give orders for a new patient. What should the nurse do to make the telephone order safer for the patient? (Select all that apply.)
a.
Refuse to accept the telephone order and request that the physician come to the unit to write the order.
b.
Accept the order and perform a “read back.”
c.
Write down the telephone order as it is being given.
d.
Accept the telephone order, but write it down later.
e.
Ask another nurse to accept the telephone order.

Answer 121

ANS: B, C
The nurse should accept the order, write it down, and perform a read back. According to the Institute for Healthcare Improvement, 50% of all medication errors have been directly attributed to the failure to communicate information at the point of transition.

Question 122

A nurse is discharging a patient who primarily speaks German. Which action(s) should the nurse take to communicate effectively with the patient? (Select all that apply.)
a.
Contact interpreter services to interpret discharge instructions to the patient.
b.
Provide discharge instructions for the patient that are written in German.
c.
Ask the patient to repeat the discharge instructions back to the interpreter as he understands them.
d.
Forego the interpreter because you are just showing him how to change a dressing.
e.
Give the patient discharge instructions that are written in English.

Answer 122

ANS: A, B, C
The nurse should contact interpreter services and request a German-speaking interpreter. The nurse should provide all discharge instructions with the help of the interpreter and ask the patient to repeat back what he has heard. By using a Team STEPPS strategy “check back,” the nurse can ensure that the patient understands the discharge instructions what he needs to do for himself when he leaves.

Question 123

A nurse has received an abnormal result on a critical test for an assigned patient. The nurse has been trying to reach the resident for 20 minutes but has been unsuccessful. What should be done to ensure the best care for the patient? (Select all that apply.)
a.
Page the resident once and document this in the chart; he/she will make rounds soon.
b.
Page the attending physician.
c.
Continue to provide care for the patient, and document all actions in the medical record.
d.
Wait until the resident makes rounds to review the test results.
e.
Begin treating the patient for the test result because the nurse knows what the resident will likely order.

Answer 123

ANS: B, C
Upon receiving the critical test result, the nurse should page the resident. The nurse should document all attempts to reach the resident and all care provided to the patient. If the resident does not call the nurse back, the nurse should page the attending physician to ensure adequate care for the patient. The nurse should not withhold the test results until the resident makes rounds or begin treating the patient without a physician’s order.

Question 124

Which action(s) can the nurse take during report to ensure patient safety? (Select all that apply.)
a.
Give report at the bedside.
b.
Give report as soon as the new nurse arrives.
c.
Use I-SBAR-R during shift change report.
d.
Focus on giving report, not on answering telephones.
e.
Be prepared for report.

Answer 124

ANS: A, C, D, E
To ensure patient safety during change of shift the nurse should be prepared, give report at the bedside if possible, use I-SBAR-R, and focus on giving report and not on other distractions such as answering the telephone. The nurse should not simply give report as soon as the new nurse arrives; the off-going nurse needs to organize a report and finish any task currently being done.

Question 125

A new nurse understands that organization is key to providing safe, effective care. Which of the following actions would help to achieve this? (Select all that apply.)
a.
Memorize assignments and patient reports.
b.
Create a work organization sheet.
c.
Keep info about each patient on separate sheets of paper.
d.
Write down all pertinent patient info.
e.
Minimize distractions during report.

Answer 125

ANS: B, D, E
To provide safe, effective care, the nurse should create a work organization sheet and write down all pertinent information regarding the patient, and minimize distractions during report. The nurse should keep all information on one sheet, so that the information does not get lost. It is unrealistic to memorize assignments and patient reports. Having patient information on separate sheets of paper can become overwhelming and is not effective work organization.

Question 126

A nurse has noticed that a coworker consistently has a negative attitude, criticizes others, and even shows aggression toward other members of the health care team. Which action(s) by the nurse would help to limit time with this individual? (Select all that apply.)
a.
Try to help the coworker deal with personal problems during work.
b.
Steer clear of the coworker.
c.
Use assertive communication.
d.
Learn to say “no.”
e.
Set clear boundaries with the coworker.

Answer 126

ANS: B, C, D, E
To limit time with this coworker, the nurse should steer clear of this coworker, use assertive communication, learn to say “no,” and set clear boundaries. It would not be appropriate to help the coworker deal with personal problems during work.

Question 127

The nurse manager is in charge of a busy nursing unit. Today the nurse manager is planning to evaluate the work of nurses on the unit. Which of the following actions would help complete this task in an effective manner? (Select all that apply.)
a.
Provide feedback as necessary to staff.
b.
Verify the tasks are being performed according to standards of practice.
c.
Allow nurses to complete all tasks, even if performed incorrectly.
d.
Provide directions with clear expectations of how the task is to be performed.
e.
Evaluate the performance of the task by the staff.

Answer 127

ANS: A, B, D, E
The nurse manager should provide directions with clear expectations, intervene if the task is being performed incorrectly, verify that the tasks are being performed according to standards of practice, evaluate the performance of the task, and provide feedback as necessary. Following these steps will help the nurse manager effectively evaluate staff. A task being performed incorrectly should be stopped. It is acceptable to allow growth in skill as long as the task is being done to minimum competency.

Question 128

A newborn has several congenital anomalies incompatible with living beyond 1 month. The newborn cannot retain formula, and the temperature drops when the newborn is removed from the warmer. Two nurses who alternate caring for the baby argue about whether or not to attempt bottle feedings and whether the newborn should be removed from the warmer to be held. What is the origin of the conflict described?
a.
Ethical values
b.
Nursing role concerns
c.
Personal goals for advancement
d.
Personality differences

Answer 128

ANS: A
This situation depicts personal issues based on two separate sets of ethics or values regarding the newborn’s care. One nurse places value on nutritional needs and the other on the need for bonding. This conflict is not personality driven among the two nurses. The role of the nurse is to care for the newborn. They both want to care for the newborn, so they are meeting their nursing role; however, the conflict is based on an ethical issue about feeding and bonding.

Question 129

Of the following common areas of conflict between nurses and their patients and families, which does the nurse interpret as the most easily resolved?
a.
Issues of concern about quality of care
b.
Issues surrounding treatment decisions
c.
Issues of family involvement
d.
Issues about quality of parental care

Answer 129

ANS: A
Families typically are concerned with how well their loved one is being attended to. Conflict often arises out of concerns related to quality of care. Whereas this is something that the nurse can directly address, issues of treatment decisions, family involvement, and quality of parental care often require more discussion and intervention.

Question 130

What is the best strategy for resolving the conflict in a situation in which two staff nurses request the same vacation weeks?
a.
Accommodation
b.
Collaboration
c.
Competition
d.
Avoidance

Answer 130

ANS: B
Collaboration is the strategy that involves confrontation and problem solving. Needs, feelings, and desires of both parties are considered to create a win–win outcome. Avoidance is a lose–lose strategy for conflict resolution, which is unassertive and uncooperative. Competition is a win–lose situation in which the use of force or the use of power occurs. Accommodation is the lose–win situation in which one person accommodates the other at his or her own expense but often ends up feeling resentful and angry.

Question 131

On the unit in which you work, one nurse’s aide is usually pleasant and helpful; the other is often abrasive and angry. What is the most important basic guideline to be observed by a nurse who must resolve a conflict between the two nurse’s aides?
a.
Deal with issues, not personalities.
b.
Require the aides to reach a compromise.
c.
Weigh the consequences of each possible solution.
d.
Encourage ventilation of anger and use humor to minimize the conflict.

Answer 131

ANS: A
Dealing with the issues and not the personalities is one of seven important key behaviors in managing conflict. Whereas issues tend to be more concrete, personalities involve emotional issues. Although weighing the consequences is one of the seven key behaviors, it does not apply to this situation which involves the behaviors of the nurse’s aides. Asking parties to compromise may not always be the best approach in resolving the conflict. Although encouraging ventilation of anger and using humor are successful approaches, it is important to always deal with the issue at hand and not the personality of the person.

Question 132

One of your peers, a staff nurse, is a “potshot artist.” This nurse often makes you the butt of innuendo or teasing digs. You are fed up and decide to take action the next time it happens. What strategy should be considered as an effective way of dealing with a “sniper”?
a.
Clam up and allow the individual to fully ventilate her concern.
b.
Confront and tell the individual he/she is wrong.
c.
Coldly withdraw from the individual.
d.
Obtain group confirmation or denial of criticism raised by the individual.

Answer 132

ANS: D
When confronting the sniper, it is important to involve the rest of the staff to get a group consensus of denial or confirmation. Remember to always expose the sniper’s attack by saying, “That sounded like a put-down to me.” Clams tend to withdraw from the individual. Confronting the individual and telling him/her he/she is wrong are ways a Sherman tank would approach the situation because he/she has a strong need to be right.

Question 133

A staff nurse who has worked on the unit for 6 months voices the following concerns to another nurse: “The clinical nurse leader of the unit often follows me into the supply room and stands blocking the doorway and chats. The nurse leader makes opportunities to mention my good looks, muscular physique, or strength in the context of daily work, saying things like, ‘You’re so handsome; no wonder your patients like you.’ The nurse leader frequently touches me on the arm, the shoulder, chest, or the hair, and if I’m sitting, touches my leg. Yesterday, the nurse leader patted my arm and said, ‘You know, if we were dating, I might be able to give you lighter assignments.’ I don’t want to date the nurse leader. I just want to be left alone! What should I do?” What is the best reply?
a.
“Don’t be quite so honorable. Go on a date and see if you get better assignments.”
b.
“Confront the nurse leader with a description of the behavior and state that you want the behavior to stop.”
c.
“Go directly to the human relations office at the agency and tell them what you just told me.”
d.
“Contact your lawyer and get advice ASAP in case the nurse leader decides to turn the tables and accuse you of advances.”

Answer 133

ANS: B
There are two ways to deal with sexual harassment in the workplace: informally by confrontation and formally through a grievance procedure, keeping a record of all confrontations and statements in writing. The best first step is to confront the person directly. Then, if there is no stopping of the behavior, go to the human relations office and explain the situation. At this point, there is no need to contact a lawyer because the human relations office can handle the sexual harassment issue.

Question 134

To resolve a scheduling conflict, a nurse manager is using employment seniority. The nurse manager interprets this as
a.
a win–win strategy.
b.
a win–lose strategy.
c.
a lose–lose strategy.
d.
a compromise.

Answer 134

ANS: B
This is an example of a win–lose strategy, which underpins competition as the method of resolving the conflict. The person with the more seniority wins, and the one with the lesser seniority loses the scheduling issue. Compromise or bargaining is a modified win–lose strategy. In this instance, there is no compromise as the nurse manager uses seniority to resolve the conflict. Avoidance is a lose–lose strategy for conflict resolution, which is unassertive and uncooperative. Win–win strategies involve collaboration and problem solving, which lead to cooperation and objectivity.

Question 135

The nurse manager is attempting to resolve an interpersonal conflict between two nurses. Which action below should be done first?
a.
Determine the facts related to the situation.
b.
Schedule a meeting time for resolution.
c.
Have an accurate understanding of the problem or conflict.
d.
Have the determination to resolve the conflict.

Answer 135

ANS: C
The first step is to make sure that the nurse manager has an accurate understanding of the problem or conflict. The quality of the outcome of resolving a problem depends on proper recognition and identification of the problem or issue. This assessment is best addressed by determining the nature of the differences and the reasons for them. After this has been achieved, the next steps would be identifying the conflicting facts and developing ways to implement a plan for resolution.

Question 136

During a staff meeting, an upset nursing assistant tells the group that the other nursing assistants are given easier patient assignments and are always given their choice of days off. What approach by the nurse manager would be effective to resolve this conflict?
a.
Attempt to persuade the upset nursing assistant to calm down.
b.
Tell the group that this type of conversation needs to be handled privately.
c.
Consider transferring the upset nursing assistant to another unit.
d.
Acknowledge the feelings of the upset nursing assistant and make a plan to meet.

Answer 136

ANS: D
Acknowledging the nursing assistant’s feelings is the first step in conflict resolution. This process requires dealing with issues, not personalities, by communicating openly, listening actively to the complaints, sorting out the issues, identifying key themes of the discussion, and weighing the consequences and options to resolve the conflict. Transferring the upset person avoids dealing with the conflict.

Question 137

Consider the following terms used to label different styles of handling anger—the Sherman tank, the sniper, the constant complainer, and the clam. Which of the following comments would you expect a Sherman tank to make?
a.
“That sure sounded like a put-down to me.”
b.
“How dare you accuse me of not putting away the linen!”
c.
“So, you think you know everything, eh?”
d.
“Why do we always have to rotate shifts?”

Answer 137

ANS: B
Sherman tanks attack individuals and have a strong need to prove to themselves and to others that their view of a situation is right. Their comments are abusive and abrupt and can be intimidating. Snipers take “potshots” at others and are not as openly aggressive as Sherman tanks. Constant complainers do just that—they complain but offer no solution. Clams also behave like their name—they clam up and refuse to respond when you need an answer or want to talk.

Question 138

Which action by the nurse has a potential for creating role conflict?
a.
Arguing that the nurse on the next shift is responsible for weighing a patient
b.
Failing to discuss differences with a coworker the nurse is angry with
c.
Placing the nurse’s personal achievement over that of coworkers
d.
Trying to change another nurse’s personality

Answer 138

ANS: A
Arguing with another nurse about whose responsibility it is to weigh a patient is an example of a role conflict. Failing to discuss differences is a communication conflict. Placing personal achievements about those of others is goal conflict. Trying to change another nurse’s personality is personality conflict.

Question 139

Which of the following scenarios shows an ethical conflict?
a.
A nurse who consistently speaks poorly of another nurse for always being “grumpy”
b.
A nurse who has a hard time respecting “no codes” on young patients
c.
A nurse who refuses to run a systems check on the glucometers because “it’s night shift’s duty”
d.
A nurse who forgets to alert family members to a change in visiting hours

Answer 139

ANS: B
A nurse who has a hard time respecting “no codes” on young patients is experiencing an ethical conflict. A nurse who speaks poorly of another nurse has a personality conflict. A nurse who refuses to run controls on a glucometer has a role conflict. A nurse who forgets to alert family members to a change in visiting hours has a communication conflict.

Question 140

A nurse is aware that an area of conflict between nurses and patients’ families is quality of parental care. Which action would not help the nurse reduce conflict?
a.
Become frustrated with the parents for lack of participation in care.
b.
Model positive parenting techniques.
c.
Encourage parents to meet other parents.
d.
Give out information about parenting classes.

Answer 140

ANS: A
To reduce conflict that nurse can model positive parenting techniques, encourage parents to meet other parents and give out information about parenting classes. The nu

Question 141

What can staff nurses do to reduce conflict with patients and families?
a.
Allow nurses to enforce what they feel comfortable with.
b.
Keep treatment decisions between the patient and health care team only.
c.
Do not allow family to participate in patient care.
d.
Maintain consistency in enforcing rules and policies.

Answer 141

ANS: D
To reduce conflict with patients and families, the nurse can maintain consistency in enforcing rules and policies. Allowing each nurse to enforce rules they are comfortable with, keeping treatment decisions between the patient and the health care team, and not allowing family to participate in care may increase conflict.

Question 142

A nurse is frustrated about being scheduled on a holiday that had been requested off, but a new nurse with less seniority was given the holiday off. Which action by the nurse shows accommodation?
a.
The nurse works out a schedule change with the new nurse.
b.
The nurse doesn’t mention the issue but feels angry and frustrated.
c.
The nurse works the holiday while the new nurse has the day off.
d.
The nurse requests to have the day before the holiday off.

Answer 142

ANS: C
Accommodation occurs when the nurse decides to work the holiday while the new nurse has the holiday off. Collaboration occurs when the nurses work out a schedule change. Avoidance occurs when the nurse doesn’t bring the issue to the attention of the new nurse but feels angry and frustrated. Compromise occurs when the nurse requests to have the day before the holiday off.

Question 143

A nurse feels angry over a patient assignment and feels that assignments always include the “bad ones.” What is the best way to control this anger?
a.
Ignore the negative feelings.
b.
Talk about the charge nurse in order to vent.
c.
Face this anger and determine what is being felt.
d.
Refuse to speak to any coworkers for fear of lashing out.

Answer 143

ANS: C
The nurse should face the anger and determine what is being felt. Ignoring angry feelings, talking about coworkers behind their backs, and ignoring others will not help to resolve the anger.

Question 144

Which statement by the nurse is true regarding sexual harassment?
a.
“Sexual harassment no longer occurs in the workplace.”
b.
“Sexual harassment is only caused by men.”
c.
“The most common sexual harassment complaint is inappropriate remarks and touching.”
d.
“Nothing can be done to prove sexual harassment.”

Answer 144

ANS: C
The most common sexual harassment complaint is inappropriate remarks and touching. The statements that “sexual harassment no longer occurs in the workplace,” “sexual harassment is only caused by men,” and “nothing can be done to prove sexual harassment” are false.

Question 145

A female nurse is experiencing sexual harassment in the workplace by a male nurse. Which action should this nurse take to stop the sexual harassment?
a.
Ignore the comments made by the male nurse.
b.
Laugh about the comments.
c.
Tell the male nurse to stop.
d.
Begin to sexually harass the male nurse.

Answer 145

ANS: C
The nurse should take the most direct route and tell the male nurse to stop. Ignoring the comments, laughing at them, or sexually harassing the male nurse will not stop the harassment.

Question 146

What action(s) by the staff nurse is an effective way to deal with a sexual harassment issue in the workplace? (Select all that apply.)
a.
Tell the person to stop.
b.
Tell your best friend about the incident.
c.
File a formal grievance.
d.
Explain the situation to your spouse.
e.
Play along with the person and document the activities.
f.
Threaten the person with a sexual harassment lawsuit.

Answer 146

ANS: A, B, C, D
There are two ways to deal with sexual harassment workplace conflict, informally and formally through a grievance procedure. Start with the most direct measure. Ask the person to STOP! Tell the harasser in clear terms that the behavior makes you uncomfortable and that you want it to stop immediately. In addition, put your statement in writing to the person, keeping a copy for yourself. It is also important to tell other people (e.g., family members, friends, your personal physician, your minister) that this is happening and how you are dealing with it.

Question 147

Which of the following are common factors of conflict encountered in nursing? (Select all that apply.)
a.
Ambiguous boundaries around work responsibilities
b.
Unclear communication to family members about visiting hours
c.
Nursing assistant placing personal achievement above everything
d.
Chief of medicine demanding that the nurse/patient ratio be increased
e.
Consideration of 26-week termination of pregnancy by a physician because of mother’s health
f.
Vacation schedules posted with new staff members having to work at least one day during all holidays

Answer 147

ANS: A, B, C, D, E, F
All of these areas are potential factors that can precipitate conflict in a nursing situation—roles, communication, goals, personalities, and conflicting ethics and values.

Question 148

What is important for the nurse manager to understand about resolving conflict in the workplace? (Select all that apply.)
a.
Realize that most new graduates use competition as a form of conflict response.
b.
Effective role socialization reduces negative conflict behaviors among nursing staff.
c.
Use of collaboration to solve conflict issues is an important strategy to encourage.
d.
Thinking like a nurse promotes role socialization and reduces conflict.
e.
Nurse managers need to create working environments that facilitate professional practice.
f.
High self-esteem fosters entitlement-type behavior that promotes conflict.

Answer 148

ANS: B, C, D, E
New graduates use compromise and avoidance as primary means of conflict resolution based on current research. High self-esteem is often found in empowering workplace environments where successful positive conflict resolution occurs. Effective role socialization, positive professional practice environments, using collaboration, and thinking like a nurse are noted in effective conflict resolution situations.

Question 149

What are some positive results that can come from conflict? (Select all that apply.)
a.
Disturbing issues are brought out, which may lead to more serious conflict.
b.
Group cohesiveness may increase as individuals resolve issues.
c.
Results of conflict can be constructive.
d.
Groups can learn from each other.
e.
Talking about issues can avert serious conflict.

Answer 149

ANS: B, C, D, E
Positive aspects of conflict include group cohesiveness increasing as individuals resolve issues, results of conflict being constructive, and groups learning from each other and talking about issues can avert serious conflict.

Question 150

A nurse is caring for an older adult patient when conflict regarding treatment arises between the family and the health care provider. What can the nurse do to resolve this conflict? (Select all that apply.)
a.
Defend the health care provider’s treatment, and try to explain it to the family.
b.
Try to convince the family that the health care provider knows what is best for the patient.
c.
Allow the family to participate in the decision-making process for their loved one.
d.
Encourage the family to speak directly to the health care provider regarding treatments.
e.
Clarify the health care provider’s order with the family.

Answer 150

ANS: C, D, E
The nurse should avoid defending the health care provider’s treatment and convincing the family that the health care provider knows what is best. Instead the nurse should allow the family to participate in the decision-making process, encourage the family to speak directly to the health care provider regarding treatments, and clarify orders with the family.

Question 151

Which of the following statements by the nurse about unresolved conflict are true? (Select all that apply.)
a.
“Conflict makes nursing staff more productive.”
b.
“Conflict reduces productivity among staff.”
c.
“Conflict wastes time.”
d.
“Conflict wastes energy.”
e.
“Conflict increases teamwork.”

Answer 151

ANS: B, C, D
Unresolved conflict reduces productivity, decreases teamwork, and wastes time and energy. Nursing staff are not more productive with unresolved conflict, and this type of conflict does not increase teamwork.

Question 152

What actions can a nurse implement into daily practice to reduce conflict? (Select all that apply.)
a.
Deal with issues and not personalities.
b.
Worry about themselves and no one else.
c.
Communicate openly.
d.
Listen actively.
e.
Sort out issues.

Answer 152

ANS: A, C, D, E
To reduce conflict, nurses can implement the following actions into their daily practice: deal with issues and not personalities, communicate openly, listen actively, and sort out issues.