Balzer Riley: Communication in Nursing, 7th Edition Chapter 04: Understanding Each Other: Communication and Culture

Balzer Riley: Communication in Nursing, 7th Edition Chapter 04: Understanding Each Other: Communication and Culture MULTIPLE CHOICE 1. A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? 2. The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about delivering care to diverse clients? 3. The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client? 4. The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best? 5. The nurse is interviewing a Native American client. It is most important for the nurse to take which action? 6. The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate? 7. The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse? 8. A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective? 9. Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse? 10. Which characteristic would the nurse use to define culture? Select all that apply. Chapter 07: Warmth Test Bank MULTIPLE CHOICE 1. The nurse greets a patient who is admitted to the hospital. Which action by the nurse displays warmth and concern? 2. A nurse manager asks a colleague for advice on strategies to improve communication with staff nurses. Which response by the nurse manager’s colleague is best? 3. The nurse observes a student nurse who demonstrates nonverbal expressions that are cold and convey disinterest when caring for patients. Which statement, if made by the nurse, is best? 4. A nurse preceptor is assigned to help several graduate nurses assess their ability to convey warmth to patients. Which activity, if selected by the nurse preceptor, is best? 5. The nurse has implemented a plan to improve expression of warmth to other nurses. It is most important for the nurse to include which evaluation method? 6. A patient is irritable and complains to the nurse about difficulty sleeping last night. Which response by the nurse is most appropriate? 7. A patient reports to the nurse, “My doctor is not doing anything about my pain.” Which response by the nurse is assertive and expresses warmth? 8. Which facial feature, if displayed by the nurse, best conveys warmth? 9. The nurse cares for a patient who has metastatic cancer. Which action(s) by the nurse conveys warmth? Select all that apply. Chapter 08: Respect Test Bank MULTIPLE CHOICE 1. The nurse cares for a client who does not follow dietary recommendations for treatment of heart failure. Which statement, if made by the nurse, demonstrates respect for the client? A. “It doesn’t make any difference to me whether you decide to eat healthy or not.” B. “You will get more attention from your physician, if you follow diet restrictions.” C. “I care about you even if you are not following your dietary restrictions.” D. “Have you noticed that patients who eat healthy foods receive better health care?” ANS: C The nurse demonstrates respect by giving unconditional acceptance of the client’s ideas, feelings, and experiences without conditions. The nurse demonstrates respect with statements that convey caring; respectful statements make the client feel important and valued. The nurse is not demonstrating respect if conditions for acceptance (i.e., “more attention” or “better health care”) are required. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 94 2. The nurse is caring for a client who is diagnosed with type 1 diabetes mellitus. Which nursing action would most likely improve client compliance with the therapeutic regimen? A. Consistently ignore negative statements made by the client. B. Avoid touching the client to reduce tension and uneasiness. C. Focus on the physical aspects of care such as insulin administration. D. Listen attentively to the client’s perception of having a chronic illness. ANS: D Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is communicated by giving the client undivided attention and listening to the client’s perceptions. Other actions that demonstrate respect include appropriate contact by gently touching the client, listening to both positive and negative client statements without judgments, and giving attention to the client as a whole (body, mind, and spirit). DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 94 3. The home care nurse is assigned to make the first home visit to a new client who has been discharged from the hospital. After initial introductions the nurse should take which action to convey respect? A. Ask the client to develop a list of needs to discuss at the next visit. B. Wear a name badge that clearly identifies the home care agency. C. Provide contact information for several other clients who can serve as references. D. Tell the client that information obtained will not be shared with others. ANS: B The home care nurse can convey respect at the initial visit by wearing a name badge that clearly identifies the home care agency. Another action that conveys respect during the initial visit is to determine the client’s needs; the nurse should not wait until the next visit. In addition, the nurse must respect the client’s right to confidentiality; client contact information should not be shared with other clients. Also, the nurse should not promise to keep secrets because the nurse must use clinical judgment about shared information that might cause potential harm to the client or someone else. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 95 4. The nurse prepares to obtain a health history from a hospitalized patient. Which action by the nurse is appropriate? A. Set time limits for the interview to reduce cost. B. Avoid asking questions that may upset the patient. C. Respect the patient’s privacy by closing the door. D. Stand at the foot of the bed to maintain eye contact. ANS: C The nurse should ensure privacy before engaging in a discussion of confidential matters when obtaining a health history. The nurse should allow for adequate time for the client to discuss the health history. The nurse must be able to discuss sensitive health issues with clients; the nurse should establish rapport and respectfully discuss sensitive subjects. The nurse should avoid standing over the patient; the nurse should be at eye level with the patient. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 96 5. The nurse instructs a client who is diagnosed with hypertension about weight reduction and dietary guidelines. Which action by the nurse would most likely improve the client’s willingness to lose weight and eat healthy foods? A. Avoid interacting with the client during meals to prevent embarrassment. B. Ignore the client’s requests for foods that are high in fat or calories. C. Give genuine praise to the client for trying to improve dietary habits. D. Warn the client that individuals who are overweight will be treated differently. ANS: C Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is given when the nurse recognizes the client for efforts to improve health. The nurse who either avoids or ignores the client is demonstrating disrespectful behavior. Treating a client differently because of noncompliance is disrespectful. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 95 6. The nurse cares for elderly clients in an assisted living center. Which action by the nurse would best show respect for these clients? A. Patronize clients who share ideas or voice concerns. B. Identify health care needs by listening to the clients. C. Address the clients formally by their last name. D. Limit the clients’ opportunities to express opinions. ANS: B The nurse shows respect by listening to clients discuss ideas, concerns, or health care needs. The nurse should not belittle, judge, demean, or patronize clients; these actions are disrespectful. The nurse demonstrates respect by asking the clients their preferences for being addressed; not all elderly clients want to be called by their last names. The nurse demonstrates respect by providing opportunities for the clients to express opinions. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 94 MULTIPLE RESPONSE 7. The nurse cares for an adult client who is diagnosed with active tuberculosis. Which action, if performed by the nurse during introductions, show respect for the client? Select all that apply. Chapter 09: Genuineness Test Bank MULTIPLE CHOICE 101, 102 1. An experienced nurse is supervising a student nurse in an acute care setting. Which statement, if made by the experienced nurse, would be most appropriate to help the student nurse establish credibility with other nurses on the unit? A. “It is impossible to be credible when you are a student because you lack experience.” B. “Try to hide your feelings of inadequacy and portray a sense of confidence.” C. “Be honest with the nurses about your strengths and about areas that need improvement.” D. “It would help if you bring special treats for the nurses so that they will like you.” ANS: C Building of trust is the most important reason for being genuine; being genuine is important in gaining credibility with colleagues. An individual can be genuine and credible without extensive experience. Genuineness occurs when both verbal and nonverbal behaviors are congruent. Being liked is not equivalent to being genuine or being honest. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 103 2. Which individual is displaying thoughts or actions that are genuine? MULTIPLE RESPONSE 3. A nurse openly discusses thoughts and feelings about sexually transmitted infections with a group of college students. Which benefit(s) may occur for these college students? Select all that apply. 4. A nurse seeks to improve self-confidence when caring for hospice patients. Which action(s) would be most appropriate? Chapter 10: Empathy Test Bank MULTIPLE CHOICE 1. The nurse cares for a patient with a terminal illness. Which way would be the most therapeutic for the nurse to communicate with this patient? *2. The nurse cares for the mother of a child who died in the emergency room as a result of an accidental poisoning. Which response by the nurse is appropriate? 3. A young mother who fractured her leg is sobbing with her face hidden behind her hands. She says to the nurse, “I will not be able to work for at least 2 months. Without my job, I cannot pay my bills or take care of my baby. I am alone and do not have anyone to help me.” Which response by the nurse accurately conveys empathy? 4. The nurse cares for a patient who becomes confused and a vest restraint is applied. The nurse should take which action when notifying the patient’s family? *5. Which situation(s) would be appropriate for the nurse to communicate with empathy? Select all that apply. Chapter 11: Self-Disclosure Test Bank MULTIPLE CHOICE 1. A patient asks the nurse to make a decision for her about whether or not to continue taking hormone replacement therapy (estrogen). Which response by the nurse is most appropriate? 2. The nursing supervisor instructs a group of novice nurses about the appropriate use of self-disclosure with patients. The nursing supervisor determines that teaching was successful if the novice nurse makes which statement? 3. The nurse cares for an elderly patient in a long-term care center. Which would be inappropriate for the nurse to share with the client? A. Reminisce about birthday celebrations and inquire about the client’s traditions. B. Use high levels of intimacy to help the client feel more comfortable with the nurse. C. Establish a helping relationship based on trust by sharing a personal story with the client. D. Share with the client how meditation decreased nausea during chemotherapy treatment. ANS: B The following are recommendations for the sharing of self in a geriatric practice: 1) Self-disclosure helps the client get to know the nurse without the burden of high levels of intimacy; 2) Reminiscence is enhanced in elders when they are encouraged to share specific events (e.g., speak of personal holiday traditions and question clients about theirs); 3) Understand that the connection between nurse and patient is dynamic, and the perception of the nurse as a real person aids in establishing the helping relationship; 4) The nurse’s sharing of self may help decrease the client’s anxiety and diminish the stress of illness and treatment. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 130 4. A patient is attracted to the nurse and attempts to initiate a social relationship. It is most appropriate for the nurse to take which action? A. Encourage the client’s behavior to develop a trusting nurse-client relationship. B. Inform the charge nurse of the situation and ask for a different patient assignment. C. Tell the patient that the relationship must remain professional at all times. D. Determine if the patient can be transferred to another nursing care unit. ANS: C Attraction may occur if the client attempts to turn a professional relationship into a social relationship. Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. The nurse should tell the client that it is important for the relationship to remain professional. The nurse should not encourage the client’s behavior; attraction does not build trust in the nurse-client relationship. The nurse should attempt to talk with the patient instead of avoidance by either requesting a different patient assignment or transferring the patient to another unit. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 127 PRIORITIZING/ORDERING 5. The nurse plans to use self-disclosure to aid a mother and father in the grieving process after the death of their child. The steps of a helpful self-disclosure appear below. Arrange the steps in the correct order of use. A. Succinctly share a personal experience that is a similar grieving experience. B. Listen to the parents talk about their child and observe their movements and gestures. C. Reflect upon the parent’s statements to communicate understanding. D. Seek verification that the self-disclosure was helpful to the child’s parents. ANS: B, C, A, D The steps to successfully implement helpful self-disclosure are: 1) Actively listen to the parents’ verbal and nonverbal messages; 2) Reply with an empathic response; 3) Self-disclose for the benefit of the parents; and 4) Check to see if the empathic response and self-disclosure were effective. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 129 Chapter 12: Specificity Test Bank MULTIPLE CHOICE 1. The nurse instructs the nursing assistant to obtain temperatures on four patients and report abnormal findings immediately. Two hours later the nurse discovers that one of the patients had a fever that was not reported. The nurse is upset with the nursing assistant. Which statement, if made by the nurse, is concrete and specifically explains the nurse’s feelings? A. “I am not dissatisfied with your performance, because we all make mistakes.” B. “You must have misunderstood. I wanted to know about any elevated temperatures.” C. “I am disappointed because you did not follow my directions.” D. “You have made me so angry. Why did you not report the fever to me?” ANS: C When communicating feelings clearly and specifically, the individual must choose the descriptor that exactly conveys the intended emotion. Adding a rationale for the feeling enhances the sincerity of the message. If the emotion is one of feeling upset, the term “disappointed” is clear and specific. The descriptor “not dissatisfied” is the opposite of the feeling of “upset.” The descriptor “angry” is a much stronger feeling than “upset.” The statement “you must have misunderstood” does not convey the nurse’s feelings about the situation. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 137 2. The nurse cares for a patient who complains of back pain. Which question should the nurse ask to obtain specific information about the back pain? A. “Would you like medication for the pain?” B. “What have you been doing in the last few days?” C. “Do you have a family history of osteoporosis?” D. “What do you think caused the back pain?” ANS: D To obtain specific information, the nurse must specifically ask for it (e.g., ask the patient about possible causes for the pain). It is more appropriate for the nurse to initially ask for the patient’s perspective than about specific causes (e.g., osteoporosis or activity). The nurse should assess before taking action (e.g., offering pain medication); the intervention does not provide specific information about the back pain. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 138 3. A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate? A. “I will teach the students how to read nutrition labels.” B. “What would you like the students to learn about nutrition?” C. “The students need to know about the consequences of obesity.” D. “I will enjoy teaching the students everything I know about nutrition.” ANS: B It is important to focus on the aspects of nutrition that the teacher wants the students to know and that are most important for them. The nurse should not assume the students need to learn about nutrition labels or obesity. Comprehensive nutrition information may waste time, be irrelevant, or focus on material that is too frightening or too advanced. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 139 4. Which statement, if made by the nurse, could positively affect the course of the patient’s illness by suggestibility? A. “Breastfeeding will provide time to bond with your baby.” B. “Breastfeeding will take longer than giving your baby a bottle.” C. “You will need to be careful about taking medications while breastfeeding.” D. “Breastfeeding mothers can develop infections that are serious.” ANS: A The placebo effect is language or expectations of a nurse that positively affect the course of the patient’s illness by suggestibility. Breastfeeding does take more time, but the nurse can send a positive message (e.g., increased time for bonding). The nocebo effect can occur when a nurse sends a negative message through choice of language, words, or tone of voice that produces negative responses (e.g., breast feeding takes time, limits medication options, and causes infections). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 140 MULTIPLE RESPONSE 5. The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient’s electronic medical record. Which key point should the nurse educator include in the teaching plan? Select all that apply. A. A patient who is at high risk for falls will require more frequent documentation. B. The nurse should not use labels (e.g., good, drug-seeking, lazy) to describe patients. C. Detailed and specific documentation is only required if a malpractice suit is expected. D. Each entry by the nurse in the electronic medical record should be clear and concise. E. Documentation cannot be used to determine reimbursement for health care services. F. Exact statements (in quotations) from patients are more accurate than paraphrasing. ANS: A, B, D, F The complexity of the health problems and the level of risk posed by patients, by their condition, or by the use of medical, nursing, or other therapies dictate the detail and frequency of documentation. The higher the risk to which a particular patient is exposed, the more comprehensive, in depth, and frequent should be the nursing recordings. Effective recording shuns bias, avoiding tendencies to prejudge or label patients. Avoidance of a malpractice suit is a valid reason for documentation to be detailed and specific, but documentation should be detailed and specific for every patient. Clear, concise documentation is vital for every entry into the electronic medical record. Careful documentation affects the ability of a health care agency to be reimbursed for services. Effective documentation tends toward quantitative expression, avoiding vague generalizations. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 139, 140 Chapter 13: Asking Questions Test Bank MULTIPLE CHOICE 1. A client with metastatic cancer complains of severe, unrelieved pain even though appropriate pain medication has been prescribed. The home care nurse plans to ask the client questions to determine why the pain medication is not working. Which action would be most appropriate if the nurse doubts the client will understand the reason for asking these questions? A. Avoid asking any questions that might make the client feel uneasy or upset. B. Inform the client’s caregiver to maintain trust in the nurse-client relationship. C. Tell the client that the questions will help to determine a better plan to control the pain. D. Refrain from disclosing the reason for asking the questions until the end of the visit. ANS: C If there is any doubt as to whether the client will understand the nurse’s reasons for asking questions, the nurse should explain those reasons in advance. If clients understand the purpose, they are more likely to be open and to reveal information, rather than being guarded because they are uneasy about the nurse’s intentions. The client’s caregiver can also be informed, but it is vital that the client is informed. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 144, 145 2. A nurse is uncomfortable asking patients about their sexual practices and behaviors. It is most appropriate for the nurse to take which action? A. Avoid asking these questions unless the patient initiates a discussion on sexual behaviors. B. Practice asking these types of questions in a simulated situation with a colleague. C. Ask a nurse who is comfortable with these types of questions to interview the patient. D. Tell the patient that asking sexual questions is difficult and uncomfortable for a nurse. ANS: B To improve the ability to be at ease when asking questions in a variety of areas, the nurse may rehearse with friends or colleagues. If the nurse cannot overcome being uncomfortable with asking sexual questions, the nurse should be honest with the patient or have another nurse interview the patient. The nurse should not avoid asking questions regarding sexual behavior. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 146 3. The nurse questions a patient with hypertension before developing a teaching plan. Which question, if asked by the nurse, is most appropriate? A. “How long have you had hypertension?” B. “Are you taking any blood pressure medications?” C. “What do you know about hypertension?” D. “Do you understand why salt is bad for you?” ANS: C Open questions (e.g., “What do you know about hypertension?”) invite respondents to elaborate in whatever direction they choose. Closed questions are focused and posed to elicit specific and brief responses from clients. Questions (e.g., “Are you taking any blood pressure medications?” or “Do you understand why salt is bad for you?”) that only require a “yes” or “no” do not invite the patient to elaborate further about the experience. Questions that require a short answer (e.g., “How long have you had hypertension?”) do not provide an opportunity for the patient to elaborate further about hypertension. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 149 4. An experienced nurse supervises a novice nurse interviewing a patient. The experienced nurse should intervene if which is observed? A. The novice nurse uses simple language instead of medical terms. B. The novice nurse avoids asking the patient “why” questions. C. The novice nurse leaves the patient without providing feedback. D. The novice nurse asks mostly open-ended health-history questions. ANS: C The nurse should give patient-feedback after an interview to help the patient feel connected and respected. Patients feel left out when nurses end an interview without giving them any indication of the assessment. Informing patients of what is happening, including plans and what patients can expect, provides helpful transitions so that they can map their progress, feel included, and minimize worrying about erroneous assumptions. The nurse should use simple language, avoid “why” questions, and use mostly open-ended questions. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 149, 150 MULTIPLE RESPONSE 5. Which technique(s) should be avoided when the nurse questions patients? Select all that apply. A. Use questions that are worded clearly with words the patient understands. B. Provide a detailed explanation to introduce the rationale for the questions. C. Offer the patient options and tell the patient which option is preferred. D. Avoid asking a patient “why” by rephrasing the question if possible. E. Ask three to five questions at a time and then allow the patient to answer. ANS: B, C, E The nurse should provide a concise statement as a rationale for questioning. If the nurse offers the patient options, the nurse should allow the patient time to speak and make a decision without interruptions. The nurse should not ask a string of questions because the patient may become confused and not know what information is important or where to begin answering. The nurse should not use medical terminology, abbreviations, or medical jargon that the patient does not understand. When asking the patient questions, the nurse should refrain from using “why” by rephrasing the question so it is softer and more receivable. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 147, 148 Chapter 14: Expressing Opinions Test Bank MULTIPLE CHOICE 1. A nurse manager has set a goal to improve professional communication on the unit. The staff nurses have attended a session on how to distinguish between expressing opinions and giving advice. Which statement, if made by a staff nurse, indicates that further teaching is needed? A. “Nurses who express opinions give patients the opportunity to make choices.” B. “Patient safety is enhanced if nurses have confidence in their ability to communicate.” C. “Giving advice leads to independent decision making by patients.” D. “Expressing opinions or recommendations is an assertive behavior.” ANS: C Giving advice is a unilateral process of solving problems or making decisions for others; giving advice prevents patients from becoming independent. Assertive communication occurs when nurses express opinions or offer recommendations. Expressing opinions assists patients in their decision making and fosters independence. Having confidence in the ability to communicate can help prevent miscommunication, a significant threat to the safety of hospitalized patients. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 153 2. The nurse is a member of a quality improvement project team to improve communication when a patient is transferred to another unit. Which statement by the nurse is appropriate to demonstrate positive regard for the team members? A. “We have done an excellent job.” B. “We still have so much work to do.” C. “Most of our suggestions did not work.” D. “We won’t win a prize for our work.” ANS: A Giving specific positive feedback is another form of expressing opinions that can demonstrate an assertive communication style. Sharing positive opinions helps team members feel comfortable, share ideas, and promote creativity and teamwork. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 157 3. A new blood glucose bedside monitoring system is introduced at a staff meeting. A nurse who has previously used this system remembers that the meter would show error messages frequently. Which statement by the nurse demonstrates assertiveness? A. “Why did no one ask for my opinion? I should have been involved in this decision.” B. “This meter does not work like it should, and I refuse to use this system ever again.” C. “I had problems with this meter before, but I will use it and let you know what I think.” D. “I have experience with this system, and there were never any serious problems.” ANS: C Nurses may feel powerless if decisions are made without their input or with which they disagree. Nurses can make a choice about when to share their disagreement even if they see no choice but to comply with the decision. Voicing disagreement makes the nurse feel more authentic and assertive. Assertiveness is a matter of choice and is not necessary or appropriate in every situation. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 158 MULTIPLE RESPONSE *4. Which nurse statement(s) is/are examples of expressing opinions in an assertive way with colleagues? Select all that apply. A. “Do you think this project will help you learn about evidence-based practice?” B. “I will tell you about the evidence-based project, and you will want to help.” C. “I recently attended an evidence-based conference. Can I share the highlights?” D. “I think we should be paid because this project will save money. What do you think?” E. “I really think you should read more evidence-based journal articles.” ANS: A, C, D To avoid generating feelings of hostility or resentment, the nurse should ask colleagues if they are interested in hearing the nurse’s viewpoint. The nurse should avoid being dogmatic or using strong phrases when expressing opinions. The nurse should be tentative about offering persuasions to show consideration of others’ special circumstances. When offering an opinion, the nurse should give others a fair chance to accept or reject ideas. When expressing opinions to colleagues, the nurse should give the rationale in a responsible way; the nurse should offer a reason for his or her preferences and then turn the final decision back to the client. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 155, 156 5. A nurse who frequently corrects other staff nurses is trying to avoid making comments when it really does not matter. In which situation(s) would it be appropriate for the nurse to remain silent and not share an opinion? Select all that apply. A. A staff nurse reports a blood pressure as 110/60 but it is recorded in the chart as 114/62. B. A staff nurse takes a lunch break for 33 minutes instead of 30 minutes. C. A staff nurse gives a medication orally instead of by injection. D. A staff nurse reports no discrepancy for the narcotic count, but one is missing. E. A staff nurse does not pronounce the generic name of a medication correctly. ANS: A, B, E Nurses need to know when to express opinions and when not to share opinions and have the strength not to always be right. The nurse should not share opinions when it does not make a difference (e.g., insignificant differences in blood pressure readings, taking an extra 3 minutes for lunch, mispronunciation of medical terms with colleagues). Opinions should be expressed if patient safety is involved (e.g., administering medication by the wrong route) or there are legal ramifications (e.g., a controlled substance is missing). DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 157 Chapter 15: Humor Test Bank MULTIPLE CHOICE 1. A nurse instructs colleagues about the use of humor with patients. Which statement, if made by a colleague, indicates that the teaching is effective? A. “Telling a joke is the best way to use humor.” B. “Humor can help patients to be less afraid.” C. “I should avoid humor when giving a bath.” D. “Patients will not talk to me if I use humor.” ANS: B Humor improves the patient’s ability to cope with stress and fear. Droll humor is more effective than formal jokes. Humor may help to put a patient at ease during a bath. Humor invites interaction. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 161 2. The nurse supervises the care of residents in an assisted living center. The nurse should intervene if which is observed? A. A nursing assistant remains silent when a resident tells a demeaning joke. B. A nursing assistant and resident laugh together while watching television. C. Two nursing assistants laugh at themselves after spilling a pitcher of water. D. A nursing assistant makes a joke about a confused resident to other residents. ANS: D Medical humor that is used by health care providers to cope is appropriate when kept among staff because it permits sharing of frustration and promotes group cohesion; this type of humor is negative if used with clients (e.g., other residents) and is demeaning and inappropriate. If demeaning humor is used, an assertive response is to remain quiet. It is appropriate for a health care worker to share positive humor (e.g., laugh while watching a television show) with clients. The highest form of positive humor is the ability to laugh at ourselves. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 161, 162 3. A patient who is scheduled for open heart surgery is nervous and tense. The nurse tries to use humor to reduce tension, but the patient seems offended. Which response by the nurse is most appropriate? A. “That joke usually works to relieve tension. Let me try another one to make you laugh.” B. “You need to lighten up a little bit because patients who are anxious have more pain.” C. “I was trying to ease your tension about surgery, and I am sorry for my insensitivity.” D. “Haven’t you ever heard that laughter is the best medicine? Just try to at least smile.” ANS: C If humor is used, and it offends the patient, the nurse should apologize and explain that the intention was to be helpful. If the patient is offended, the nurse should not continue to use humor. The nurse should not tell a patient how to feel or behave (e.g., “you need to lighten up” or “try to at least smile”) or suggest that certain behaviors will increase pain. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 163 4. The nurse prepares to administer the first chemotherapy treatment to a patient. Which statement by the nurse encourages a positive attitude? A. “What brings joy to your life?” B. “Will you be upset if you lose your hair?” C. “What are your concerns about your treatment?” D. “How do you usually cope with stress?” ANS: A The nurse can encourage a positive attitude by asking patients appropriate questions such as: 1) “What brings joy to your life?” 2) “What do you do for fun?” or 3) “What is going well for you today?” Asking a patient about being upset, concerns, or stress does not focus on generating a positive attitude. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 166 MULIPLE RESPONSE 5. Which function(s) of humor in nursing practice has been substantiated by research? Select all that apply. A. Conflicts that occur between nurses and physicians can be managed with humor. B. A patient with a disability may use humor as an effective coping strategy. C. The nurse should not use humor to intervene when a patient is embarrassed. D. A nurse can use humor to establish rapport with a patient who is anxious. E. Positive humor is most appropriate if initiated by the nurse and not the patient. F. Nurses who have a sense of humor are better accepted by patients. ANS: A, B, D, F Evidence supports the use of humor in nursing practice to: 1) cope with conflicts between nurses and physicians; 2) help patients cope with disabilities; 3) establish relationships and rapport; 4) improve the patient’s acceptance of the nurse; and 5) to help nurses intervene when patients are embarrassed. Humor may be inappropriate unless initiated by patients or family members. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 163, 164 Chapter 16: Spirituality Test Bank MULTIPLE CHOICE 1. An elderly patient asks the nurse if faith and regular prayer have any effect on health and longevity. Which response by the nurse is most appropriate? A. “It doesn’t matter what I think, because your beliefs about religion are most important.” B. “You will need to ask a chaplain because I am not allowed to discuss religion.” C. “Health benefits are only associated with individuals who attend church every week.” D. “There is evidence that religious practices are associated with health and living longer.” ANS: D Over 250 studies show that religious practice (e.g., faith and regular prayer) is correlated with greater health and increased longevity. The patient is not asking what the nurse believes about prayer; the patient is asking about evidence relating faith and prayer to health and longevity. It is within the scope of practice for the nurse to address spiritual issues in clinical practice. Findings from over 70 data-based, peer-reviewed published papers show that people who attend religious services on a regular basis have better health outcomes, stronger immune systems, lower stress, and recover from hip fractures and open-heart surgeries more quickly than do less religious people. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 174 2. The nurse provides spiritual care for hospice patients. Which action by the nurse should be completed first? A. Perform spiritual assessments with hospice patients. B. Practice techniques to enrich spirituality and centeredness. C. Determine available resources in the community. D. Practice the art of presence with the patients. ANS: B Nurses must nurture their own spirit before being able to stay connected to the experience of a patient. Practicing techniques (e.g., relaxation techniques, meditation, time in nature, yoga, music) helps nurses to be in touch with their own spirituality and with becoming centered. It is only then that nurses are effective in spiritual assessments, being present, and identifying resources. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 177 3. Which nurse is being fully present with the patient to provide spiritual care? A. The nurse sits quietly with a patient and uses therapeutic touch. B. The nurse gathers a complete health history from a patient. C. The nurse asks if the patient would like the chaplain to visit. D. The nurse reassures a patient while giving medications. ANS: A Spiritual care begins with being fully present; nursing presence is a conscious act of being fully present in body, mind, emotions, and spirit with a patient. Being silent and use of therapeutic touch are examples of being present. Performing tasks or assessments (e.g., obtaining a health history, administering medications) are not examples of being fully present. Spiritual care is more than religion or visitation from a chaplain. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 178 4. The nurse senses the patient has more to say and wants to encourage the patient to continue talking. It is most appropriate for the nurse to state: A. “I think you may not be telling me everything.” B. “How does that make you feel?” C. “Oh …. ?” and wait for the patient to continue. D. “Why do you feel that way?” ANS: C Use encouraging or questioning sounds or body language as cues to encourage the patient to continue talking. Try “Oh ... ?” when you sense that the client has more to say and then be quiet. Avoid the question “How does that make you feel?” which may make patients believe they are being analyzed. Refrain from using “why” because doing so tends to make patients feel threatened. It is better to rephrase the question so it is softer and more receivable. The nurse should not indicate that the patient may be lying or withholding information. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 180 MULTIPLE RESPONSE 5. The nurse is taking a spiritual history from a patient with a terminal illness. Which question(s), if asked by the nurse, would be appropriate? Select all that apply. A. “Would you like me to serve as your spiritual counselor?” B. “What gives your life meaning?” C. “What importance does your faith have for you? D. “Why do you think your spirituality has not saved you?” E. “Are you part of a religious community?” F. “How can I help you address your spiritual needs?” ANS: B, C, E, F The Faith and Belief: Importance, Community, and Address in Care (FICA) tool suggests appropriate questions for taking a spiritual history (see Box 16-1). The nurse may assume the role of spiritual guide to extend love, compassion, and empathy but not to become the patient’s spiritual counselor. It is usually best to refrain from using “why” to ask questions because patients may feel threatened; it is better to rephrase the question so it is softer and more receivable. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: pp. 174, 176 Chapter 17: Requesting Support Test Bank MULTIPLE CHOICE 1. A nurse manager seeks to reduce staff nurses’ stress and promote retention. It is most important for the nurse manager to take which action? A. Develop a mentoring program to provide cognitive and affective support. B. Focus on cognitive support instead of affective or physical support. C. Limit affective support to annual recognition of nurses’ accomplishments. D. Place the highest priority on purchasing equipment to provide for physical support. ANS: A A mentoring program can provide cognitive and affective support; mentor programs have improved retention of nurses. Cognitive, affective, and physical support are equally important to reduce stress and promote retention of nurses. Affective support is acknowledgment for the work nurses do; respect, honor, and recognition should be continually provided and not just during annual reviews or evaluations. Physical support is provided with having the staff, materials, and processes to complete the work; however, staffing is an essential component of physical support and directly linked to retention of nurses. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 191 2. A new graduate nurse feels that the staff nurses are not empathetic and do not provide reassurance or positive feedback. Which action by the graduate nurse is appropriate? A. Use an antagonistic approach to seek support from a nurse who is a mentor. B. Use a nonassertive approach to seek physical support from the staff nurses. C. Use an assertive approach to seek affective support from the nurse manager. D. Use an aggressive approach to seek cognitive support from other graduate nurses. ANS: C Affective support is acknowledgment for the work a nurse does and a feeling of nurturance; the graduate nurse would seek affective support using an assertive approach if a lack of empathy, reassurance, and positive feedback were identified. Cognitive support helps the nurse think intelligently and solve problems. Physical support is the provision of staff, materials, and processes needed to get the work done. Nonassertive, aggressive, or antagonistic approaches are not effective to gain support. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 191 3. A nurse is breastfeeding but has no private, sanitary area to pump breast milk while working; she also discovers that at least 10 other employees at the hospital have the same problem. Which action by the nurse would most likely result in acquiring a clean, private area to pump breast milk? A. The nurse demands that the nursing director provide a private area within one week. B. The nurse develops a clear, detailed plan and suggests several possible private areas. C. The nurse sends an e-mail to the nursing supervisor with a description of the problem. D. The nurse writes a letter to the nurse manager and asks others to add their signatures. ANS: B If the nurse develops a specific and clear plan with sufficient detail, the greater are the chances of obtaining physical support (e.g., a private area). Demanding a space is an aggressive approach that does not give respect to the nursing director. The nurse should make an appointment with the nursing supervisor or manager and not communicate by e-mail or letter. The nurse should not just describe the problem but also offer solutions. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 192 MULTIPLE RESPONSE 4. The nurse manager decides to initiate a mentoring program for new graduate nurses on a medical unit. The nurse manager should consider asking which nurse(s) to serve as mentors? Select all that apply. A. A nurse who excels in nursing knowledge and skills and has a positive attitude. B. A nurse who has excellent communication skills and a positive outlook. C. A nurse who is certified in psychiatric care and works in a mental health setting. D. A nurse who excels as a manager and has an advanced degree in administration. E. A nurse who is warm, empathetic, and has a passion for nursing and helping others. ANS: A, B, E A mentor in nursing represents excellence in knowledge, skill, and competence; affective components are warmth, acceptance, friendliness, empathy, compassion, patience, a willingness to learn and share, and generosity. Mentors have a positive outlook, are loyal and nurturing, enjoy nursing, and have superior communication skills. A nurse with an advanced degree or with certification in a specialty area will not necessarily have the characteristics of a good mentor. DIF: Comprehension TOP: Integrated Process: Caring MSC: Safe and Effective Care Environment: Management of Care REF: p. 200 PRIORITIZING/ORDERING 5. Three emergency department (ED) nurses are interested in initiating a new policy related to family presence during cardiopulmonary resuscitation (CPR). The steps to request support for initiation of this policy are listed below. Arrange the steps in the correct order of use? A. The nurses review literature and survey ED nurses about family presence during CPR. B. The nurses practice their presentation to the nurse manager. C. The nurses identify the need to gain support from the nurse manager for this policy. D. The nurses decide to approach the nurse manager with their idea. E. The nurses develop a specific strategy to present the information to the nurse manager. ANS: C, D, A, E, B The nurses should follow the steps for requesting cognitive support: 1) The first step is to identify their need for support; 2) The next step is to decide if they wish to pursue this support; 3) Once they have decided to try to obtain the support, they must obtain information (e.g., literature review, survey ED nurses); 4) The next step is to design their strategy to present the information; and 5) The nurse should prepare for the presentation to the nurse manager. DIF: Application TOP: Nursing Process: Planning MSC: Safe and Effective Care Environment: Management of Care REF: p. 192 Chapter 19: Feedback Test Bank MULTIPLE CHOICE 1. A licensed practical/vocational nurse (LPN/LVN) consistently forgets to administer medications and asks the registered nurse (RN) for specific advice. It is most appropriate for the RN to make which statement? A. “Buy a digital watch with an alarm, and you will never forget again.” B. “Something that helps me is to set the alarm on my watch as a reminder.” C. “You should set the alarm on your watch as a reminder to give medications.” D. “It is best if you set the alarm on your watch when the next medication is due.” ANS: B When giving advice, the RN should offer options as suggestions for the LPN/LVN’s consideration. Suggestions will be more readily received if offered tentatively (e.g., “Something I’ve tried is this.”). If the RN gives advice by telling the LPN/LVN how to change without giving the option to decide, the LPN/LVN’s feelings may be hurt, or the LPN/LVN may not feel respected. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 215 2. The nurse manager of a critical care unit initiates three-hundred-and-sixty degree feedback as a tool to aid in the development of the staff nurses. Who will provide feedback on each nurse’s performance? A. Nurse manager, other staff nurses, and nursing assistants B. Patients, family members, and hospital volunteers C. Physicians, respiratory therapists, and other specialists D. Chief executive officer, nursing director, and nurse manager ANS: A Three-hundred-and-sixty-degree feedback, or multisource performance approval data, is used as a staff development tool because feedback is drawn from peers and subordinates to supplement direct observation by the manager. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 215 3. The nurse cares for a patient who is admitted to the medical unit. The patient has type 2 diabetes mellitus, a blood glucose of 420 mg/dL, and a foot ulcer. Which statement, if made by the nurse, is appropriate when giving feedback to this patient? A. “I am going to tell you what you are doing wrong because I know about diabetes.” B. “You have this foot ulcer because you did not follow your diet and exercise plan.” C. “From my perspective, the foot ulcer occurred because your blood sugars are high.” D. “I know you don’t want to hear this, but uncontrolled diabetes leads to complications.” ANS: C The nurse gives feedback respectfully, if phrases such as “From my perspective ...” are used; the nurse uses the first person to convey thoughts and feelings which prevents accusing or labeling the patient’s behavior. The nurse should not give feedback to display superior knowledge or to rigidly control the behavior of a patient. The nurse should gain permission from the patient to give feedback. The nurse should not give feedback that is general; feedback should focus on specific, observable behavior. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: pp. 215, 216 4. A new nurse wants feedback from the other more experienced nurses on the unit. Which request for feedback, if made by the new nurse, would be most appropriate? A. “How do you think I am doing?” B. “I would like to know my strengths and weaknesses.” C. “I still feel incompetent but would like some feedback.” D. “What do you think about the accuracy of my assessments?” ANS: D The new nurse should be specific when requesting feedback by clarifying the aspects of a behavior (i.e., assessment accuracy). The new nurse should avoid vague questions (e.g., “How do you think I am doing?”). The new nurse should not ask for feedback until confident enough to examine the feedback. Receiving feedback with implications for change when unconfident may only serve to make the new nurse feel worse. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 219 PRIORITIZING/ORDERING *5. The nurse is concerned about a nursing assistant who does not immediately report vital signs that are out of normal range. Arrange the nurse’s statements below in the correct order to give assertive feedback to the nursing assistant. A. “I would prefer that you notify me immediately if vital signs are abnormal.” B. “The patients with abnormal vital signs are not evaluated in a timely manner.” C. “When you take vital signs, you do not report abnormal values to me immediately.” D. “I feel uncomfortable because the patients are not receiving safe nursing care.” ANS: C, B, A, D The nurse should give assertive feedback when there is a difficult situation with a nursing assistant. The nurse should follow this formula to give assertive feedback: 1) When you ... (describe the behavior without judging it); 2) The effects are ... (describe concretely how it affects the individual’s life in a practical sense); 3) I feel ... (describe feelings without blaming; the “I” statement implies ownership of feelings); and 4) I prefer ... (describe what response or change is desired, or, if possible, give the other person a chance to come up with a solution). Prefer  Feel DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management of Care REF: p. 217 Chapter 20: Relaxation Test Bank MULTIPLE CHOICE 1. The nurse supervises a nursing assistant who reports feeling stress and not being able to relax. When talking with the nursing assistant, which statement by the nurse is best? A. “I suggest meditation, but meditation works better if you eat a healthy diet.” B. “Relaxation strategies do not work until you learn to control negative emotions.” C. “All you need to do to relieve stress is take short breaks and get eight hours of sleep.” D. “You will be more relaxed if you stop wasting time being with close friends.” ANS: A Relaxation strategies (e.g., meditation) work best when a person is not totally depleted. To make the best use of relaxation skills, self-care needs should be met. Self-care should include eating nutritious foods, taking breaks while at work, dealing with emotions (e.g., with fear, frustration, hurt) that lead to anger, nurturing relationships with others, and getting eight hours of sleep. DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 222 2. Which activity, if performed by the nurse, can improve patient safety? A. Pass up breaks to provide more time for patient care. B. Consume processed foods to increase energy level. C. Practice progressive relaxation exercises every day. D. Remain alert by not practicing meditation before work. ANS: C Daily relaxation techniques (e.g., progressive relaxation, meditation) eliminate the negative build-up of stress and help nurses become more focused and alert, promoting safety for clients and for themselves. Stress is a result of unhealthy habits (e.g., eating processed foods, not taking breaks). DIF: Application TOP: Integrated Process: Caring MSC: Psychosocial Integrity REF: p. 223 3. A supervisor instructs a nurse on how to use meditation to relax and to reduce stress. Which statement, if made by the nurse, indicates teaching is successful? A. “I can use meditation to reduce tension if stressful situations occur on the unit.” B. “If distracting thoughts occur while meditating, I will focus on these thoughts.” C. “I should practice meditation for at least 15 minutes every day.” D. “Meditation is most effective for people with strong religious beliefs.” ANS: C To experience benefits from meditation, it is desirable to meditate for 15 to 20 minutes at least once a day. This commitment means setting aside that time consistently. Although meditation is rooted in spiritual traditions, the practice of meditation does not require belief in any particular religious or cultural system. Distracting thoughts are likely to occur during meditation, especially at first; the nurse should let these thoughts pass without becoming worried. Meditation can help the nurse learn to maintain a calm perspective, but meditation is not practical while on the unit. DIF: Application TOP: Integrated Process: Teaching/Learning MSC: Psychosocial Integrity REF: pp. 224, 225, 227 4. The nurse teaches a client about relaxation techniques that can be used to reduce situational stress. Which statement by the client requires an intervention from the nurse? A. “Relaxation techniques can give me self-confidence and a feeling of competence.” B. “If an angry person is going to talk to me, I can imagine myself getting a massage.” C. “I should use abdominal breathing to help me relax in stressful situations.” D. “Progressive stretching exercises are more effective than meditation to relieve stress.” ANS: D Muscle stretches augment the benefits of meditation and on-the-spot exercises; relaxation strategies are equally effective in reducing stress. Relaxation techniques can change feelings of tightness and fear to relaxation and a feeling of competence and create inner self-confidence. Imagery (e.g., of massage) can help a person cope with an unexpected stressful interpersonal encounter. Abdominal breathing is an on-the-spot method for relaxing the body. DIF: Application TOP: Integrated Process: Teaching/Learning MSC: Psychosocial Integrity REF: pp. 228-230 MULTIPLE RESPONSE 5. Which are known causes of workplace stress for nurses? Select all that apply. A. Increased acuity of patients B. Shortage of personnel C. Increase in available resources D. Reduced workload E. Distressing patient situations F. Communicating with colleagues ANS: A, B, E, F Causes of stress in nursing include the following: 1) Increased acuteness of clients’ conditions; 2) shortage of personnel; 3) distressing and anxiety-provoking situations; 4) changing exposure to different personnel in a complex working environment; 5) insufficient resources; and 6) excessive workload DIF: Comprehension TOP: Safe and Effective Care Environment: Management of Care MSC: Psychosocial Integrity REF: p. 223 Chapter 21: Imagery Test Bank MULTIPLE CHOICE 1. A nurse attends an education session on effective communication. Which statement, if made by the nurse, indicates an understanding of how imagery may be used to build confidence when communicating with patients and colleagues? A. “Imagery is most successful if visualizations are ambiguous and constrained.” B. “Imagery will only be effective if individuals are actively involved in the visualizations.” C. “Imagery works because the brain does not discriminate between thoughts and actions.” D. “Imagery is a process of using pictures to remember past events with positive regard.” ANS: C Research supports the idea that imagery works because the brain does not distinguish between an image and the experience of the imagined place or situation. Imagery is most successful if the visualization is clear and the course of action is committed; there should be neither limitations nor constraints. Not everyone images the same way. Some individuals are actively involved in the image, while others see it as actors on a stage or get only sensory impressions without a clear image. Imagery or visualization is a process of mentally picturing an event we wish to occur in the present or future. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: pp. 233, 234 2. Which change indicates to the nurse that a patient is responding favorably to using imagery? A. The patient’s blood pressure is better controlled. B. The patient develops maladaptive coping strategies. C. The patient’s healing time is increased. D. The patient’s immune response is suppressed. ANS: A Imagery is an effective intervention to control blood pressure, to promote coping, to optimize healing, and to improve the immune response. DIF: Comprehension TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity REF: pp. 235, 236 3. The nurse plans to use imagery as an alternative language when removing a urinary catheter. Which statement, if made by the nurse, would be most appropriate? A. “Removing a catheter really hurts.” B. “You will not feel anything.” C. “It will be briefly painful.” D. “You may feel a burning sensation.” ANS: D The nurse can use imagery when performing procedures. Imagery as an alternative language is truthful but suggests a different sensation than anticipated. When removing a urinary catheter, the nurse would describe the sensation as “burning” instead of as “painful” or “really hurts.” This language decreases anxiety and shifts the pattern from response to “pain” to response to “burning.” The nurse should convey sensations that are truthful; the nurse should avoid statements such as “You will not feel anything.” DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 236 4. The nurse instructs a colleague about how imagery can build confidence when communicating with other health care providers. The nurse determines further teaching is necessary if the colleague makes which statement? A. “Visualizations are most effective if the focus is on preparation for the encounter.” B. “Before visualization I will clearly determine the desired outcome.” C. “It is important to take three or four deep breaths before using imagery.” D. “If I practice imagery regularly, the technique will be more effective.” ANS: A To be more prepared, the colleague should visualize the entire interaction which includes prior to the interaction (or preparation time), the interaction (or direct encounter), and postinteraction. By mentally going through the whole encounter, you will be much better prepared. The individual must be clear about what will be communicated and determine the desired outcome. Imagery is most effective when the person is relaxed, so the person should begin imagery with three deep breaths to facilitate relaxation. It is important to practice imagery because the person will be able to go through the steps quickly and effectively. DIF: Application TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity REF: p. 238 MULTIPLE RESPONSE 5. Which imagery techniques would improve a nurse’s communication skills? Select all that apply. A. Self-confidence will be improved if the nurse critically reviews communication errors. B. If the interaction will be stressful, the visualization should be practiced several times. C. Actual words and actions sho