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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.
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While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed?
- A. Nonverbal communication
- B. A message filter
- C. A cultural barrier
- D. Social skills
Correct Answer: A
Rationale: Eye contact and body movements are considered nonverbal communication. Insufficient data are available to determine the level of the patient's social skills or whether a cultural barrier exists.
A Puerto Rican-American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient's behavior?
- A. A histrionic personality disorder is likely.
- B. A belief that dramatic body language is sexually appealing.
- C. Wishes to impress staff with the degree of emotional pain.
- D. Belongs to a culture in which dramatic body language is the norm.
Correct Answer: D
Rationale: Members of Hispanic-American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.
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.
Documentation in a patient's chart shows, 'Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you."' Which analysis is most accurate?"
- A. Patient is giving positive feedback about the nurse's communication techniques.
- B. Nurse is viewing the patient's behavior through a cultural filter.
- C. Patient's verbal and nonverbal messages are incongruent.
- D. Patient is demonstrating psychotic behaviors.
Correct Answer: C
Rationale: When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a 'mixed message.' It is inaccurate to say that the patient is giving positive feedback about the nurse's communication techniques. The concept of a cultural filter is not relevant to the situation; a cultural filter determines what a person will pay attention to and what he or she will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.
Which technique will best communicate to a patient that the nurse is interested in listening?
- A. Restate a feeling or thought the patient has expressed.
- B. Ask a direct question, such as, 'Did you feel angry?'
- C. Make a judgment about the patient's problem.
- D. Say, 'I understand what you're saying.'
Correct Answer: A
Rationale: Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Closed-ended questions such as 'Did you feel angry?' ask for specific information rather than show understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.