Nokea
A Filipino-American patient avoided eye contact when interacting with the nurse. The nurse concluded that the patient had low self-esteem. Interventions were used to raise the patient's self-esteem; however, after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario?
- A. The patient's eye contact should have been directly addressed by role-playing to increase comfort with eye contact.
- B. The nurse should not have independently embarked on treatment planning for this patient.
- C. The patient's poor eye contact is indicative of anger and hostility that remain unaddressed.
- D. The nurse should have assessed the patient's culture before concluding the patient had low self-esteem.
Correct Answer: D
Rationale: The amount of eye contact in which a person engages is often culturally determined. In some cultures, eye contact is considered insolent, whereas in other cultures, eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.
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A patient tells the nurse, 'I don't think I will ever get out of here.' Select the nurse's most therapeutic response.
- A. Don't talk that way. Of course, you will leave here.
- B. Keep up the good work and you certainly will.
- C. You don't think you're making progress?
- D. Everyone feels that way sometimes.
Correct Answer: C
Rationale: By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to 'talk that way' is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.
A patient says to the nurse, 'I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well.' Which comment would be appropriate if the nurse seeks clarification?
- A. It sounds as though you were uncomfortable with the content of your dream.
- B. I understand what you're saying. Bad dreams leave me feeling tired, too.
- C. So, all in all, you feel as though you had a rather poor night's sleep?
- D. Can you give me an example of what you mean by 'stoned'?
Correct Answer: D
Rationale: The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient's statement. Asking for a definition of 'stoned' directly asks for clarification. Restating that the patient is uncomfortable with the dream's content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient's comment.
During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. How should the nurse respond?
- A. You've turned the tables on me.'
- B. Nurses direct the interviews with patients.'
- C. Do not ask questions about my personal life.'
- D. The time we spend together is to discuss your concerns.'
Correct Answer: D
Rationale: When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse's personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Saying 'You've turned the tables on me' states the fact but does not refocus the interview.
A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
- A. What are the common elements here?
- B. Tell me again about your experiences.
- C. Am I correct in understanding that...?
- D. Tell me everything from the beginning.
Correct Answer: C
Rationale: Asking, 'Am I correct in understanding that...?' permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.
Which benefits are most associated with the use of telehealth? (Select all that apply.)
- A. Cost savings for patients
- B. Maximization of care management
- C. Access to services for patients in rural areas
- D. Prompt reimbursement by third-party payers
- E. Rapid development of trusting relationships with patients
Correct Answer: A,B,C
Rationale: Use of telehealth technologies has shown that they can maximize health and improve disease management skills and confidence with the disease process. Many rural patients have felt disconnected from services; telehealth technologies can solve these problems. Although telehealth's improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third-party payers. Telehealth is not associated with rapid development of trusting relationships.