Communication in Nursing Test Bank

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Mr. U (pulmonary resection) has developed a tension pneumothorax. He is currently receiving high-flow oxygen via nonrebreather mask but continues to experience respiratory distress. What is the priority action?

  • A. Remove the occlusive dressing around the chest wound.
  • B. Perform a needle thoracotomy with a 14- to 16-gauge catheter needle.
  • C. Initiate cardiopulmonary resuscitation (CPR).
  • D. Call for the crash cart and intubation equipment.
Correct Answer: B

Rationale: The correct answer is B: Perform a needle thoracotomy with a 14- to 16-gauge catheter needle.

Rationale:
1. Tension pneumothorax is a life-threatening emergency where air accumulates in the pleural space, causing lung collapse and increased pressure in the chest.
2. The standard treatment for tension pneumothorax is needle thoracostomy, which involves inserting a large-bore needle into the chest to release the trapped air.
3. In this scenario, Mr. U is in respiratory distress despite receiving high-flow oxygen, indicating a significant problem with ventilation that requires immediate intervention.
4. Performing a needle thoracotomy will rapidly decompress the tension pneumothorax, relieving pressure on the heart and lungs, and improving respiratory function.
5. This action takes precedence over other options such as removing the occlusive dressing, initiating CPR, or calling for intubation equipment, as immediate decompression is crucial in managing tension pneumoth

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It would be most important for the nurse to temporarily withdraw expressions of warmth to which patient?

  • A. A 20-year-old patient who is angry and throwing objects.
  • B. A 32-year-old patient who is withdrawn and refuses nursing care.
  • C. A 48-year-old patient who is extremely anxious about surgery.
  • D. A 56-year-old patient who has a history of violent behavior.
Correct Answer: D

Rationale: The correct answer is D because the patient with a history of violent behavior poses a potential risk to the nurse's safety. Temporarily withdrawing expressions of warmth is important to establish boundaries and ensure safety. Choice A involves an angry patient, but the risk of violence is higher with a history of violent behavior. Choices B and C do not indicate immediate safety concerns.

The nurse manager asks the staff nurse to work an extra shift. Which response by the staff nurse is assertive and based on rational beliefs?

  • A. "I don't want you upset, so I will work extra."
  • B. "Why do I always have to cover extra shifts?"
  • C. "I am not able to work an extra shift."
  • D. "If you can't find anyone else, I will do it."
Correct Answer: C

Rationale: The correct answer is C because it directly and assertively communicates the staff nurse's inability to work an extra shift. This response sets clear boundaries and respects the nurse's own limitations and well-being. It is based on rational beliefs as it acknowledges personal capacity without guilt or unnecessary explanations.

Explanation of other choices:
A: This choice is not assertive as it prioritizes avoiding upsetting the nurse manager over the nurse's own needs and boundaries.
B: This response is confrontational and does not address the request directly, focusing instead on questioning past occurrences.
D: While this response offers to work the extra shift as a last resort, it does not assert the nurse's own limitations clearly, leaving room for potential guilt or manipulation.

The author describes the patient journey as driving down a country road and somehow getting lost. At that moment and time, all that is needed is clear directions about how to get to your destination, not about types of entertainment in the area. The same is true for patients. Accordingly, a part of each nursing assessment should include:

  • A. Patient's need for information and level of understanding
  • B. Detailed overview of disease process
  • C. Specific examples from other patients with same disease
  • D. Nurse's feelings about newest treatment modality
Correct Answer: A

Rationale: Step 1: Understanding the patient's need for information and level of understanding is crucial to providing appropriate care.
Step 2: Clear directions are necessary to guide patients, just like clear information is needed to guide their healthcare decisions.
Step 3: Assessing the patient's need for information helps tailor education to their level of understanding.
Step 4: This choice directly aligns with the analogy of providing clear directions for patients on their healthcare journey.
Summary: Choice A is correct as it emphasizes the importance of assessing the patient's need for information and understanding, which is essential for guiding them effectively. Choices B, C, and D are incorrect as they do not directly address the patient's need for information and understanding in the analogy provided.

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.
Correct Answer: D

Rationale: The correct answer is D because listening attentively to the client's perception of having a chronic illness is crucial for building trust, understanding their concerns, and fostering a therapeutic relationship. By actively listening, the nurse can address any misconceptions, provide education tailored to the client's needs, and involve the client in decision-making, ultimately improving compliance.

Choice A is incorrect as ignoring negative statements can lead to feelings of neglect and hinder communication. Choice B is incorrect as avoiding touching the client may create a barrier to building rapport. Choice C is incorrect as focusing only on physical care neglects the psychological and emotional aspects of managing a chronic condition like diabetes.

The nurse cares for a patient who has metastatic cancer. Which action(s) by the nurse conveys warmth? (Select all that apply)

  • A. Avoid distracting actions such as hand gestures.
  • B. Show interest by occasional head nodding.
  • C. Lean forward toward the patient at a 45-degree angle.
  • D. Place arms across the chest to prevent fidgeting.
Correct Answer: B

Rationale: The correct answer is B: Show interest by occasional head nodding. This action conveys warmth by demonstrating active listening and engagement with the patient. It shows empathy and understanding without being intrusive.

Avoiding distracting actions such as hand gestures (A) may come across as cold or disinterested. Leaning forward toward the patient at a 45-degree angle (C) can be perceived as invading personal space. Placing arms across the chest to prevent fidgeting (D) may appear defensive or closed off, lacking warmth and openness.

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