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The nurse is preparing a client for electroconvulsive therapy (ECT). After the client signs the informed consent form for the procedure, a family member states, 'I don't think that this ECT will be helpful, especially since it makes people's memory worse.' What form of communication should the nurse implement to address the family member's concern?
- A. Ask other family members and the client if they think that ECT makes people worse.
- B. Immediately reassure the client and family that ECT will help and that the memory loss is only temporary.
- C. Involve the family member in a dialog to ascertain how the family member arrived at this conclusion.
- D. Reinforce with the client and the family member that depression causes more memory impairment than ECT.
Correct Answer: C
Rationale: Involving the family member in a dialog allows the nurse to understand their concerns and provide accurate information about ECT, addressing misconceptions about memory loss. Option 1 shifts focus away from the family member's concern, option 2 provides premature reassurance without exploring the concern, and option 4 makes an assumption about the cause of memory impairment without addressing the family member's specific worry.
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While in the hospital, a client was diagnosed with coronary artery disease (CAD). Which question by the nurse is likely to elicit the most useful response for determining the client's degree of adjustment to the new diagnosis?
- A. Is there anyone to help with housework and shopping?'
- B. How do you feel about making changes to your lifestyle?'
- C. Do you understand the schedule for your new medications?'
- D. Did you make a follow-up appointment with your provider?'
Correct Answer: B
Rationale: Exploring feelings assists the nurse with determining the individualized plan of care for the client who is adjusting to a new diagnosis. The correct option is the best question to ask the client because it is likely to elicit the most revealing information about the client's feelings about CAD and the requisite lifestyle changes that can help maintain health and wellness. The remaining choices are aspects of post-hospital care, but they are unlikely to uncover as much information about the client's adjustment to CAD because they are closed-ended questions.
The nurse working on the mental health unit is in the orientation (introductory) phase of the therapeutic nurse-client relationship. Which intervention is representative of this phase of the relationship?
- A. The nurse and client determine the contract for time.
- B. The client is encouraged to make use of all services depending on need.
- C. The client begins to identify with the nurse, and trust and rapport are maintained.
- D. The nurse focuses on facilitating the therapeutic expression of the client's feelings.
Correct Answer: A
Rationale: In the orientation (introductory phase) of the therapeutic nurse-client relationship, the client and nurse meet and determine the contract for time, such as how often to meet, the length of the meetings, and when termination is anticipated to occur. Utilizing services, identification with the nurse, and expression of feelings are appropriate for the working phase of the therapeutic nurse-client relationship.
A teenaged client is discharged from the hospital after surgery with instructions to use a cane for the next 6 months. What question best demonstrates the nurse's ability to use therapeutic communication techniques to effectively assess the teenager's feelings about using a cane?
- A. How do you feel about needing a cane to walk?'
- B. Do you have questions about ambulating with a cane?'
- C. Are you worried about what your friends will think about your cane?'
- D. What types of problems do you think you'll have ambulating with a cane?'
Correct Answer: A
Rationale: The nurse effectively uses therapeutic communication techniques when posing an open-ended question to elicit assessment data about how the teenager feels about using a cane. The remaining options are closed-ended questions. Option 3 makes assumptions about how the teenager feels, and options 2 and 4 focus on the physical aspects of using the cane.
The nursing student is listening to a lecture on correcting errors in a written narrative on a medical record. Which statement by the nursing student indicates that the teaching has been effective?
- A. The correct procedure is to document the correction as a late entry.'
- B. The correct procedure is to draw a line through the error to identify it.'
- C. The correct procedure is to remove the error in a manner approved by the facility.'
- D. The correct procedure is to cover the error completely using a permanent marker.'
Correct Answer: B
Rationale: If the nurse makes a narrative documentation error in the client's record, the agency's policy should be followed to correct the error. Agency policy usually includes drawing one line through the error, initialing and dating the line, and then providing the correct information. The nurse uses a late entry to document additional information that was not documented at the time that it occurred. The nurse avoids attempting to remove the error by any means because these actions raise the suspicion of wrongdoing.
A client has been using crutches to ambulate for 1 week and now reports pain, fatigue, and frustration with crutch walking. How should the nurse respond when the client states, 'I feel like I will always be crippled'?
- A. Tell me what makes this so bothersome for you.'
- B. I know how you feel. I had to use crutches before too.'
- C. Why don't you take a couple of days off of work and rest?'
- D. Just remember, you'll be done with the crutches in another month.'
Correct Answer: A
Rationale: The correct option demonstrates the therapeutic communication technique of clarification and validation and indicates that the nurse is dealing with the client's problem from the client's perspective. Option 2 devalues the client's feelings and thus blocks communication. Option 3 gives advice and is a communication block. Option 4 provides false reassurances because the client may not be done with the crutches in another month. Additionally, it does not focus on the present problem.