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A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies about giving advice?
- A. It is rarely helpful.
- B. It fosters independence.
- C. It lifts the burden of personal decision making.
- D. It helps the patient develop feelings of personal adequacy.
Correct Answer: A
Rationale: Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions. Giving advice also robs patients of the opportunity to weigh alternatives and to develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.
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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.
When a female Mexican-American patient and a female nurse sit together, the patient often holds the nurse's hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior and thinks the patient is misunderstanding the nurse-patient relationship. Which alternative is a more accurate assessment?
- A. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures.
- B. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.
- C. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.
- D. The nurse is quick to make assumptions.
Correct Answer: A
Rationale: The most likely answer is that the patient's behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.
An African-American patient says to a Caucasian nurse, 'There's no sense talking. You wouldn't understand because you live in a white world.' What would be the nurse's best action?
- A. Explain, 'Yes, I do understand. Everyone goes through the same experiences.'
- B. Say, 'Please give an example of something you think I wouldn't understand.'
- C. Reassure the patient that nurses interact with people from all cultures.
- D. Change the subject to one that is less emotionally disturbing.
Correct Answer: B
Rationale: Having the patient speak in specifics rather than globally helps the nurse understand the patient's perspective. This approach helps the nurse engage the patient.
A patient cries as the nurse explores the patient's relationship with a deceased parent. The patient says, 'I shouldn't be crying like this. It happened a long time ago.' Which responses by the nurse will facilitate communication? (Select all that apply.)
- A. Why do you think you are so upset?'
- B. I can see that you feel sad about this situation.'
- C. The loss of your parent is very painful for you.'
- D. Crying is a way of expressing the hurt you're experiencing.'
- E. Let's talk about something else because this subject is upsetting you.'
Correct Answer: B,C,D
Rationale: Reflecting ('I can see that you feel sad' or 'This is very painful for you') and giving information ('Crying is a way of expressing hurt') are therapeutic techniques. 'Why' questions often imply criticism or seem intrusive or judgmental, and they are difficult to answer. Changing the subject is a barrier to communication.
The relationship between a nurse and patient as it relates to status and power is best described by which term?
- A. Symmetric
- B. Complementary
- C. Incongruent
- D. Paralinguistic
Correct Answer: B
Rationale: When a difference in power exists, as between student and teacher or nurse and patient, the relationship is said to be complementary. Symmetrical relationships exist between individuals of like or equal status. Incongruent and paralinguistic are not terms used to describe relationships.