(Test Bank) Clinical Nursing Skills and Techniques

Perry,Potter, 10

Nursing

Test Bank

10th Edition

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Test Bank for Clinical Nursing Skills and Techniques, The downloadable file consists of 605 pages, and the total size of the file is 3.46 MB. Purchase now only for highly discounted price.

Author(s): Perry, Potter

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Complete Test Bank For Clinical Nursing Skills and Techniques 10th Edition by Anne Griffin Perry, Patricia A. Potter Chapter 1 -43 Complete Guide Table Of Content Chapter 1. Using Evidence in Nursing Practice Chapter 2. Communication and Collaboration Chapter 3. Admitting, Transfer, and Discharge Chapter 4. Documentation and Informatics Chapter 5. Vital Signs Chapter 6. Health Assessment Chapter 7. Specimen Collectio n Chapter 8. Diagnostic Procedures Chapter 9. Medical Asepsis Chapter 10. Sterile Technique Chapter 11. Safe Patient Handling and Mobility (SPHM) Chapter 12. Exercise and Mobility Chapter 13. Support Surfaces and Special Beds Chapter 14. Patient Safety Chapter 15. Disaster Preparedness Chapter 16. Pain Manag ement Chapter 17. End -of-Life Care Chapter 18. Personal Hygiene and Bed Making Chapter 19. Care of the Eye and Ear Chapter 20. Safe Medication Preparation Chapter 21. Nonparenteral Medications Chapter 22. Parenteral Medications Chapter 23. Oxygen Therapy Chapter 24. Performing Chest Physiotherapy Chapter 25. Airway Management Chapter 26. Car diac Care Chapter 27. Closed Chest Drainage Systems Chapter 28. Emergency Measures for Life Support Chapter 29. Intravenous and Vascular Access Therapy Chapter 30. Blood Therapy Chapter 31. Oral Nutrition Chapter 32. Enteral Nutrition Chapter 33. Parenteral Nutrition Chapter 34. Urinary Elimination Chapter 35. Bowel Eliminat ion and Gastric Intubation Chapter 36. Ostomy Care Chapter 37. Preoperative and Postoperative Care Chapter 38. Intraoperative Care Chapter 39. Wound Care and Irrigations Chapter 40. Impaired Skin Integrity Prevention and Care Chapter 41. Dressings, Bandages, and Binders Chapter 42. Home Care Safety Chapter 43. Home Care Teaching Chapter 01: Using Evidence in Nursing Practice Perry et al.: Clinical Nursing Skills & Techniques, 10th Edition MULTIPLE CHOICE 1. Evidence -based practice is a problem -solving approach to making decisions about patient care that is grounded in: a. the latest information found in textbooks. b. systematically conducted research studies. c. tradition in clinical practice. d. quality improvement and risk -management data. ANS: B The best evidence comes from well -designed, systematically conducted resear ch studies described in scientific journals. Portions of a textbook often become outdated by the time it is published. Many health care settings do not have a process to help staff adopt new evidence in practice, and nurses in practice settings lack easy a ccess to risk -management data, relying instead on tradition or convenience. Some sources of evidence do not originate from research. These include quality improvement and risk -management data; infection control data; retrospective or concurrent chart revie ws; and clinicians‘ expertise. Although non–research -based evidence is often very valuable, it is important that you learn to rely more on research -based evidence. DIF: CognitiveLevel : Comprehension OBJ: Discuss the benefits of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment (management of care) 2. When evidence -based practice is used, patient care will be: a. standardized for all. b. unhampered by patient cultur e. c. variable according to the situation. d. safe from the hazards of critical thinking. ANS: C Using your clinical expertise and considering patients‘ cultures, values, and preferences ensures that you will apply available evidence in practice ethic ally and appropriately. Even when you use the best evidence available, application and outcomes will differ; as a nurse, you will develop critical thinking skills to determine whether evidence is relevant and appropriate. DIF: CognitiveLevel : Application OBJ: Discuss the benefits of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment (management of care) 3. When a PICOT question is developed, the letter that correspon ds with the usual standard of care is: a. P. b. I. c. c. CHOICE BLANK d. O. ANS: C C = Comparison of interest. What standard of care or current intervention do you usually use now in practice? P = Patient population of interest. Identify your patient by age, gender, ethnicity, disease, or health problem. I = Intervention of interest. What intervention (e.g., treatment, diagnostic test, and prognostic factor) do you think is worthwhile to use in practice? O = Outcome. What result (e.g., change in patie nt‘s behavior, physical finding, and change in patient‘s perception) do you wish to achieve or observe as the result of an intervention? DIF: CognitiveLevel : Knowledge OBJ: Develop a PICO question. TOP: PICO KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 4. A well -developed PICOT question helps the nurse: a. search for evidence. b. include all five elements of the sequence. c. find as many articles as possible in a literature search. d. accept standard clinical routines. ANS: A The more focused a question that you ask is, the easier it is to search for evidence in the scientific literature. A well -designed PICOT question does not have to include all five elements, nor does it have to f ollow the PICOT sequence. Do not be satisfied with clinical routines. Always question and use critical thinking to consider better ways to provide patient care. DIF: CognitiveLevel : Analysis OBJ: Describe the six steps of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 5. The nurse is not sure that the procedure the patient requires is the best possible for the situation. Utilizing which o f the following resources would be the quickest way to review research on the topic? a. CINAHL b. PubMed c. MEDLINE d. The Cochrane Database ANS: D The Cochrane Community Database of Systematic Reviews is a valuable source of synthesized evidence (i. e., pre -appraised evidence). The Cochrane Database includes the full text of regularly updated systematic reviews and protocols for reviews currently happening. MEDLINE, CINAHL, and PubMed are among the most comprehensive databases and represent the scient ific knowledge base of health care. DIF: CognitiveLevel : Synthesis OBJ: Describe the six steps of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management o f care) 6. The nurse is getting ready to develop a plan of care for a patient who has a specific need. The best source for developing this plan of care would probably be: a. The Cochrane Database. b. MEDLINE. c. NGC. d. CINAHL. ANS: C The National Guidelines Clearinghouse (NGC) is a database supported by the Agency for Healthcare Research and Quality (AHRQ). It contains clinical guidelines —systematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific patient population. The NGC is a valuable source when you want to develop a plan of care for a patient. The Cochrane Community Database of Systematic Reviews, MEDLINE, and CINAHL are all valuable sources of synthesized evidence (i.e., pre -appra ised evidence). DIF: CognitiveLevel : Synthesis OBJ: Describe the six steps of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 7. The nur se has done a literature search and found 25 possible articles on the topic that she is studying. To determine which of those 25 best fit her inquiry, the nurse first should look at: a. the abstracts. b. the literature reviews. c. the ―Methods‖ sections. d. the narrative sections. ANS: A An abstract is a brief summary of an article that quickly tells you whether the article is research based or clinically based. An abstract summarizes the purpose of the study or clinical query, the major themes or fin dings, and the implications for nursing practice. The literature review usually gives you a good idea of how past research led to the researcher‘s question. The ―Methods‖ or ―Design‖ section explains how a research study is organized and conducted to answe r the research question or to test the hypothesis. The narrative of a manuscript differs according to the type of evidence -based article —clinical or research. DIF: CognitiveLevel : Application OBJ: Discuss elements to review when critiquing the scientific literature. TOP: Randomized Controlled Trials KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 8. The nurse wants to determine the effects of cardiac rehabilitation program attendance on the level of postmyocardial depression for individuals who have had a myocardial infarction. The type of study that would best capture this information would be a: a. randomized controlled trial. b. qualitative study. c. case control study. d. descriptive s tudy. ANS: B Qualitative studies examine individuals‘ experiences with health problems and the contexts in which these experiences occur. A qualitative study is best in this case of an individual nurse who wants to examine the effectiveness of a local p rogram. Randomized controlled trials involve close monitoring of control groups and treatment groups to test an intervention against the usual standard of care. Case control studies typically compare one group of subjects with a certain condition against a nother group without the condition, to look for associations between the condition and predictor variables. Descriptive studies focus mainly on describing the concepts under study. DIF: CognitiveLevel : Synthesis OBJ: Discuss ways to apply evidence in nur sing practice. TOP: Randomized Controlled Trials KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 9. Six months after an early mobility protocol was implemented, the incidence of deep vein thrombosis in patients was decreased. This is an example of what stage in the EBP process? a. Asking a clinical question b. Applying the evidence c. Evaluating the practice decision d. Communicating your results ANS: C After implementing a practice cha nge, your next step is to evaluate the effect. You do this by analyzing the outcomes data that you collected during the pilot project. Outcomes evaluation tells you whether your practice change improved conditions, created no change, or worsened conditions . DIF: CognitiveLevel : Application OBJ: Discuss ways to apply evidence in nursing practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe and Effective Care Environment (safety and infection control) MULTIPLE RESPO NSE 1. To use evidence -based practice appropriately, you need to collect the most relevant and best evidence and to critically appraise the evidence you gather. This process also includes: ( Select all that apply. ) a. asking a clinical question. b. apply ing the evidence. c. evaluating the practice decision. d. communicating your results. ANS: A, B, C, D EBP comprises six steps (Melnyk and Fineout -Overholt, 2010): 1. Ask a clinical question. 2. Search for the most relevant and best evidence that appli es to the question. 3. Critically appraise the evidence you gather. 4. Apply or integrate evidence along with one‘s clinical expertise and patient preferences and values in making a practice decision or change. 5. Evaluate the practice decision or change. 6. Communicate your results. DIF: CognitiveLevel : Analysis OBJ: Describe the six steps of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 2. In a clinical environment, evidence -based practice has the ability to improve: ( Select all that apply. ) a. the quality of care provided. b. patient outcomes. c. clinician satisfaction. d. patients‘ perceptions. ANS: A, B, C, D EBP has the potent ial to improve the quality of care that nurses provide, patient outcomes, and clinicians‘ satisfaction with their practice. Your patients expect nursing professionals to be informed and to use the safest and most appropriate interventions. Use of evidence enhances nursing, thereby improving patients‘ perceptions of excellent nursing care. DIF: CognitiveLevel : Application OBJ: Discuss the benefits of evidence -based practice. TOP: Randomized Controlled Trials KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 3. During the application stage of evidence -based practice change, it is important to consider: (Select all that apply. ) a. cost. b. the need for new equipment. c. management support. d. adequate staff. ANS: A, B, C, D One important step for an individual or an interdisciplinary EBP committee is to consider the resources needed for a practice change project. Are added costs or new equipment involved with a practice change? Do you have ade quate staff to make the practice change work as planned? Do management and medical staff support you in the change? If the barriers to practice change are excessive, adopting a practice change can be difficult, if not impossible. DIF: CognitiveLevel : Appl ication OBJ: Describe the six steps of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) COMPLETION 1. _________________ is a guide for ma king accurate, timely, and appropriate clinical decisions. ANS: Evidence -based practice Evidence -based practice is a guide for making accurate, timely, and appropriate clinical decisions. DIF: CognitiveLevel : Knowledge OBJ: Define the key terms listed. TOP: Evidence -Based Practice KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment (management of care) 2. Evidence -based practice requires good ______________. ANS: nursing judgment Evidence -based practice requires go od nursing judgment; it does not consist of finding research evidence and blindly applying it. DIF: CognitiveLevel : Comprehension OBJ: Discuss the benefits of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment (management of care) 3. While caring for patients, the professional nurse must question ________________. ANS: what does not make sense Always think about your practice when caring for patients. Question wha t does not make sense to you, and question what you think needs clarification. DIF: CognitiveLevel : Analysis OBJ: Describe the six steps of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe an d Effective Care Environment (management of care) 4. A systematic review explains whether the evidence that you are searching for exists and whether there is good cause to change practice. In _____________, all entries include information on systematic r eviews. ANS: The Cochrane Database A systematic review explains whether the evidence that you are searching for exists and whether there is good cause to change practice. In The Cochrane Database, all entries include information on systematic reviews. DIF: CognitiveLevel : Analysis OBJ: Describe the six steps of evidence -based practice. TOP: Evidence -Based Practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 5. The researcher explains h ow to apply findings in a practice setting for the types of subjects studied in the _________________ section of a research article. ANS: ―Clinical Implications‖ Clinical Implications A research article includes a section that explains whether the findi ngs from the study have ―clinical implications.‖ The researcher explains how to apply findings in a practice setting for the types of subjects studied. DIF: CognitiveLevel : Application OBJ: Discuss elements to review when critiquing the scientific litera ture. TOP: Randomized Controlled Trials KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 6. ____________________ is the extent to which a study‘s findings are valid, reliable, and relevant to your patient population of interest. ANS: Scientific rigor Scientific rigor is the extent to which a study‘s findings are valid, reliable, and relevant to your patient population of interest. DIF: CognitiveLevel : Application OBJ: Define the key terms l isted. TOP: Randomized Controlled Trials KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) 7. Patient fall rates are an example of an ______________. ANS: outcome measurement Data collected within a health care agency offer important trending information about clinical conditions and problems. Staff in the agency review the data periodically to identify problem areas and to seek solutions. DIF: CognitiveLevel : Application OBJ: Define the key terms listed. TOP: Quality Improvement KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment (management of care) Chapter 02: Communication and Collaboration Perry et al.: Clinical Nursing Skills & Techniques, 10th Ed ition MULTIPLE CHOICE 1. The patient is a 54 -year-old man who has made a living as a construction worker. He dropped out of high school at age 16 and has been a laborer ever since. He never saw any need for ―book learning,‖ and has lived his life ―my wa y‖ since he was a teenager. He has smoked a pack of cigarettes a day for 40 years and follows no special diet, eating a lot of ―fast food‖ while on the job. He now is admitted to the coronary care unit for complaints of chest pain and is scheduled for a ca rdiac catheterization in the morning. Which of the following would be the best way for the nurse to explain why he needs the procedure? a. ―The doctor believes that you have atherosclerotic plaques occluding the major arteries in your heart, causing ischem ia and possible necrosis of heart tissue.‖ b. ―There may be a blockage of one of the arteries in your heart, causing the chest discomfort. He needs to know where it is to see how he can treat it.‖ c. ―We have pamphlets here that can explain everything. L et me get you one.‖ d. ―It‘s just like a clogged pipe. All the doctor has to do is ‗Roto -Rooter‘ it to get it cleaned out.‖ ANS: B To send an accurate message, the sender of verbal communication must be aware of different developmental perspectives as well as cultural differences between sender and receiver, such as the use of dialect or slang. DIF: CognitiveLevel: Application OBJ: Explain the communication process. TOP: Verbal Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychos ocial Integrity 2. The nurse is assessing a patient who says that she is feeling fine. The patient, however, is wringing her hands and is teary eyed. The nurse should respond to the patient in which of the following ways? a. ―You seem anxious today. Is t here anything on your mind?‖ b. ―I‘m glad you‘re feeling better. I‘ll be back later to help you with your bath.‖ c. ―I can see you‘re upset. Let me get you some tissue.‖ d. ―It looks to me like you‘re in pain. I‘ll get you some medication.‖ ANS: A When assessing a patient‘s needs, assess both the verbal and the nonverbal messages and validate them. In this case, if you see a patient wringing her hands and sighing, it is appropriate to ask, ―You seem anxious today. Is there anything on your mind?‖ It i s not enough to accept only the verbal message if nonverbal signals conflict, and it is inappropriate to jump to conclusions about what the nonverbal signals mean. DIF: CognitiveLevel: Application OBJ: Explain the communication process. TOP: Nonverbal Com munication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 3. Nonverbal communication incorporates messages conveyed by: a. touch. b. cadence. c. tone quality. d. use of jargon. ANS: A Nonverbal communication describes all behaviors that convey messages without the use of words. This type of communication includes body movement, physical appearance, personal space, and touch. Cadence, tone quality, and the use of jargon are all part of verbal communication. DIF: Cogniti veLevel: Knowledge OBJ: Explain the communication process. TOP: Nonverbal Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 4. The patient is an elderly male who had hip surgery 3 days ago. He states that his hip hurts, but he does not like how the medicine makes him feel. He believes that he can tolerate the pain better than he can tolerate the medication. What would be the best response from the nurse? a. Explain the need for the pain medication using a slower ra te of speech. b. Explain the need for the pain medication using a simpler vocabulary. c. Explain the need for the pain medication, but ask the patient if he would like the doctor called and the medication changed. d. Explain in a loud manner the need fo r the pain medication. ANS: C Suggesting, which is presenting alternative ideas for patient consideration relative to problem solving, can be effective in helping the patient maintain control by increasing the patient‘s perceived options or choices . Nurses often use elder -speak, which includes a slower rate of speech, greater repetition, and simpler grammar than normal adult speech, when caring for older adults. However, many older patients perceive this type of communication as patronizing. DIF: Cognit iveLevel: Application OBJ: Identify the purpose of therapeutic communication, communication in various phases of the nurse -patient relationship, and special issues related to communication. TOP: Communication with the Elderly KEY: Nursing Process Step: I mplementation MSC: NCLEX: Psychosocial Integrity 5. When comparing therapeutic communication versus social communication, the professional nurse realizes that therapeutic communication: a. allows equal opportunity for personal disclosure. b. allows both participants to have personal needs met. c. is goal directed and patient centered. d. provides an opportunity to compare intimate details. ANS: C Therapeutic communication empowers patients to make decisions but differs from social communication in t hat it is patient centered and goal directed with limited disclosure from the professional. Social communication involves equal opportunity for personal disclosure, and both participants seek to have personal needs met. Nurses do not share with patients in timate details of their personal lives. DIF: CognitiveLevel: Application OBJ: Develop skills for therapeutic communication in various phases of the nurse -patient relationship. TOP: Establishing the Nurse -Patient Relationship KEY: Nursing Process Step: I mplementation MSC: NCLEX: Psychosocial Integrity 6. The nurse is explaining a procedure to a 2 -year-old child. Which is the best approach to use? a. Showing the needles and bandages in advance b. Telling the patient exactly what discomfort to expect c. Using dolls and stories to demonstrate what will be done d. Asking the child to draw pictures of what he or she thinks will happen ANS: C Some age -appropriate communication techniques for a 2 -year-old child include storytelling and drawing. Showing the child needles or telling the child about discomfort would increase anxiety. Having a child draw what he expects does not explain what is going to happen. DIF: CognitiveLevel: Application OBJ: Develop skills for therapeutic communication in various ph ases of the nurse -patient relationship. TOP: Establishing the Nurse -Patient Relationship —Pediatric Considerations KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 7. The nurse is about to go over the patient‘s preoperative t eaching per hospital protocol. She finds the patient sitting in bed wringing her hands, which are sweaty, and acting slightly agitated. The patient states, ―I‘m scared that something will go wrong tomorrow.‖ How should the nurse respond? a. Redirect her fo cus to dealing with the patient‘s anxiety. b. Tell the patient that everything will be all right and continue teaching. c. Tell the patient that she will return later to do the teaching. d. Give the patient antianxiety medication. ANS: A Anxiety inte rferes with comprehension, attention, and problem -solving abilities and thus interferes with the patient‘s care and treatment. To ensure the effectiveness of treatment, the nurse should try to help the patient understand the source of the anxiety. Ignoring the anxiety, medicating for it, and postponing the discussion are all inappropriate. DIF: CognitiveLevel: Application OBJ: Develop therapeutic communication skills for communicating with anxious, angry, and depressed patients. TOP: Establishing the Nurs e-Patient Relationship KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 8. The nurse is attempting to teach the patient and his family about his care after discharge. The patient and the family demonstrate signs of anxiety during the teaching session. The nurse should consider doing what? a. Using more gestures or pictures b. Focusing on the physical complaints c. Getting another staff member to speak to the patient d. Repeating information to the patient and the family a t a later time ANS: D Remember that patients and their family members who are under stress often require repeated explanations. Increasing gestures and pictures is additional stimulation that may increase anxiety. Physical complaints should be acknowled ged, but dwelling on them can also increase the patient‘s anxiety. Involving another staff member would cause a break in the continuity of care. DIF: CognitiveLevel: Application OBJ: Develop therapeutic communication skills for communicating with anxious , angry, and depressed patients. TOP: Establishing the Nurse -Patient Relationship KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 9. The patient is an elderly man who was brought to the hospital from an assisted -living community with complaints of anorexia and general malaise. The nurse at the assisted -living community reported that the patient was very ritualistic in his behavior and fastidious in his dress and always took a shower in the evening before bed. The patient be came very angry and upset when the patient care technician asked him to take his bath in the morning. What does this behavior tell the nurse? a. The patient is exhibiting anxiety because of a change in his rituals. b. The patient is suffering from sensory overstimulation. c. The patient is basically an angry person. d. The patient has to follow hospital protocol. ANS: A Patients often become ritualistic and intent on performing activities a certain way. Anxiety develops as a result of a specific event or a general pattern of change. DIF: CognitiveLevel: Analysis OBJ: Develop therapeutic communication skills for communicating with anxious, angry, and depressed patients. TOP: Gerontological Considerations —Anxiety KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Psychosocial Integrity 10. The nurse is preparing to give an intramuscular injection to the patient in room 320. The patient care technician comes to the medication room and tells the nurse that the patient in room 316 is very angry with his r oommate and is threatening to hit him. How should the nurse respond? a. Tell the patient care technician to calm the patient down until she can get there. b. Have the angry patient‘s roommate moved to another location. c. Tell the angry patient to calm d own until she can get there. d. Tell the angry patient that he has to act civilized in the hospital, and that‘s that. ANS: B A potentially violent patient needs to be in an environment with decreased stimuli and to have protection from injury to self a nd against others. Encourage other people, particularly those who provoke anger, to leave the room or area. De -escalation is a skill that cannot be delegated to nursing assistive personnel (NAP). DIF: CognitiveLevel: Application OBJ: Develop therapeutic communication skills for communicating with anxious, angry, and depressed patients. TOP: Communicating with the Angry Patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 11. Which behavior should the nurse who is commu nicating with a potentially violent patient employ? a. Sit closer to the patient. b. Speak loudly and firmly. c. Use slow, deliberate gestures. d. Always block the door to prevent escape. ANS: C Make sure that gestures are slow and deliberate rather than sudden and abrupt. There is less chance for misinterpretation of the message, and slow, deliberate gestures are less threatening. Keep an adequate distance between yourself and the patient to reduce your risk of injury and to avoid making the patient feel pressured. Try to talk in a comfortable, reassuring voice. Position yourself closest to the door to facilitate escape from a potentially violent situation. Do not block the exit; if the patient feels unable to escape, this may cause a violent outburst . DIF: CognitiveLevel: Application OBJ: Develop therapeutic communication skills for communicating with anxious, angry, and depressed patients. TOP: Communicating with the Angry Patient KEY: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial In tegrity 12. The patient is sitting at the bedside. He has not been eating and is just staring out of the window. The nurse approaches the patient and asks, ―What are you thinking about?‖ What type of communication technique is this? a. Restating b. Clarification c. Broad openings d. Reflection ANS: C Broad openings encourage patients to select topics for discussion. They affirm the value of the patient‘s initiative. Restating is repeating a main thought that the patient has expressed. Clarification is attempting to put into words vague ideas or asking the patient to explain what he or she means. Reflection is directing back to the patient ideas, feelings, questions, or content. DIF: CognitiveLevel: Knowledge OBJ: Explain the communication process. TOP: Therapeutic Communication Techniques KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Psychosocial Integrity 13. A patient tells the nurse, ―I want to die.‖ Which response is the most appropriate for the nurse to make? a. ―Why would you say that?‖ b. ―Tell me more about how you are feeling.‖ c. ―The doctor should be told how you feel.‖ d. ―You have too much to live for to think that way.‖ ANS: B Broad openings encourage the patient to select topics for discussion and indicate acceptance by the nurse and the value of the patient‘s initiative. ―Why‖ questions can cause defensiveness and can hinder communication. Saying you will inform the doctor leads the conversation away from the patient‘s feelings. Saying the patient has too much to live for i s false reassurance and negates the patient‘s feelings. DIF: CognitiveLevel: Application OBJ: Explain the communication process. TOP: Therapeutic Communication Techniques KEY: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial Integrity 14. The patient states, ―I don‘t know what my family will think about this.‖ The nurse wishes to use the communication technique of clarification. Which of the following statements would fit that need best? a. ―You don‘t know what your family will think?‖ b. ―I‘m not sure that I understand what you mean.‖ c. ―I think it would be helpful if we talk more about your family.‖ d. ―I sense that you may be anxious about something.‖ ANS: B The definition of clarification is attempting to put into words vague ideas or unclear thoughts of the patient to enhance the nurse‘s understanding, or asking the patient to explain what he or she means. Repeating main thoughts expressed by patients is known as ―restating.‖ Using questions or statements that help patients expand on a topic of importance is known as ―focusing.‖ Asking a patient to verify the nurse‘s understanding of what the patient is thinking or feeling is known as ―sharing perceptions.‖ DIF: CognitiveLevel: Application OBJ: Explain the communication process. TOP: Therapeutic Communication Techniques KEY: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial Integrity 15. A patient tells the nurse, ―I think that I must be really sick. All of these tests are being done.‖ Which response by the nurse uses the specific communication technique of reflection? a. ―I sense that you are worried.‖ b. ―I think that we should talk about this more.‖ c. ―You think that you must be very sick because of all the tests.‖ d. ―I‘ve noticed that this is an underlying issu e whenever we talk.‖ ANS: C Reflecting is directing back to the patient ideas, feelings, questions, or content, validating the nurse‘s understanding of what the patient is saying, and signifying empathy, interest, and respect for the patient. Asking the patient to confirm your sense of his or her anxiety is ―sharing perceptions.‖ Stating that ―we should talk about this more,‖ that is, putting forth questions or statements to expand on a topic, is ―focusing.‖ Pointing out underlying issues or problems tha t occur repeatedly is known as ―theme identification.‖ DIF: CognitiveLevel: Application OBJ: Explain the communication process. TOP: Therapeutic Communication Techniques KEY: Nursing Process Step: Intervention MSC: NCLEX: Psychosocial Integrity 16. The patient is admitted to the hospital with complaints of headache, nausea, and dizziness. She states that she has a final exam in the morning and needs to do well on it to pass the course, but she can‘t seem to get into it. She appears nervous and distract ed, and is unable to recall details. She most likely is showing manifestations of _____ anxiety. a. mild b. moderate c. severe d. panic state of ANS: C Severe anxiety manifests as a focus on fragmented details, as well as headache, nausea, dizziness, inability to see connections between details, and poor recall. Mild anxiety manifests as increased auditory and visual perception, increased awareness of relationships, and increased alertness and ability to problem -solve. Moderate anxiety manifests as se lective inattention, decreased perceptual field, focus only on relevant information, muscle tension, and diaphoresis. Panic state of anxiety manifests as an inability to notice surroundings, feelings of terror, and inability to cope with any problem. DIF: CognitiveLevel: Analysis OBJ: Develop therapeutic communication skills for communicating with anxious, angry, and depressed patients. TOP: Manifestations of Anxiety KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Physiological Integrity 17. The patie nt is admitted to the emergency department for trauma received in a fist fight. He states that he could not control himself. He says that his wife left him for another man. He thinks it was because he was always too tired after working to do things. He say s he has to work, and there is nothing he could do to change things. He says that he feels trapped in his job, but he knows nothing else. What was the altercation with the other man probably a manifestation of? a. Mild anxiety b. Depression c. Severe anx iety d. Moderate anxiety ANS: B Symptoms of depression include apathy, sadness, sleep disturbances, hopelessness, helplessness, worthlessness, guilt, anger, fatigue, thoughts of death, decreased libido, ruminations of inadequacy, psychomotor agitation, verbal berating of self, spontaneous crying, dependency, and passiveness. Mild anxiety manifests as increased auditory and visual perception, increased awareness of relationships, increased alertness, and an increased ability to problem -solve. Moderate an xiety manifests as selective inattention, decreased perceptual field, focus only on relevant information, muscle tension, and diaphoresis. Severe anxiety manifests as a focus on fragmented details, headache, nausea, dizziness, an inability to see connectio ns between details, and poor recall. DIF: CognitiveLevel: Analysis OBJ: Develop therapeutic communication skills for communicating with anxious, angry, and depressed patients. TOP: Manifestations of Depression KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. Verbal communication includes which of the following? ( Select all that apply. ) a. Speech b. Personal space c. Body movement d. Writing ANS: A, D