Identify the choice that best completes the statement or answers the question.
____ 1. The nurse recognizes that in order to effectively meet the goal of shared meaning in communication, verbal and nonverbal language should be
A. Absent.
B. Congruent.
C. Equally direct.
D. Noncongruent.
____ 2. While bathing a patient, the nurse recognizes that the personal space-distance zone that he or she is in when physically touching the patient is
A. Public.
B. Intimate.
C. Casual-personal.
D. Social-consultative.
____ 3. While obtaining a patient health history, the nurse recognizes that the personal space-distance zone that he or she is in when standing within 3 feet of the patient is
A. Public.
B. Intimate.
C. Casual-personal.
D. Social-consultative.
____ 4. When interacting with a physician, the nurse recognizes that the personal space-distance zone that he or she is in when standing within 5 feet of the physician is
A. Public.
B. Intimate.
C. Casual-personal.
D. Social-consultative.
____ 5. When teaching a class of nursing students, the nursing instructor stands 15 feet from her audience. The personal space-distance zone that the nursing instructor is in is
A. Public.
B. Intimate.
C. Casual-personal.
D. Social-consultative.
____ 6. When interacting with patients, the nurse demonstrates a willingness to communicate when
A. Standing over seated patients.
B. Slumping while talking to patients.
C. Folding arms while talking to patients.
D. Leaning slightly forward toward patients.
____ 7. A patient who appears to be in pain does not ask the nurse for pain medication because he feels it would upset the nurse. The style of communication that the patient is demonstrating is
A. Passive.
B. Assertive.
C. Aggressive.
D. Demeaning.
____ 8. A patient throws his urinal at the nurse and tells the nurse that he thinks she is a terrible nurse. The nurse informs the patient that his behavior is inappropriate. The style of communication that the nurse is demonstrating is
A. Passive.
B. Assertive.
C. Aggressive.
D. Demeaning.
____ 9. When the nurse educates a patient about his medications, the patient tells the nurse that she should go back to nursing school because she doesn’t know very much about medications. The style of communication that the patient is demonstrating is
A. Passive.
B. Avoidant.
C. Assertive.
D. Aggressive.
____ 10. A nursing instructor teaches a class of student nurses that the most effective communication style for nurses to practice is
A. Passive.
B. Avoidant.
C. Assertive.
D. Aggressive.
____ 11. A nurse is caring for a patient who has end-stage renal disease and will require dialysis three times per week. The patient states, “I’m upset that I didn’t visit all the places I’d like to see. Now that I’m on dialysis I won’t be able to.” The most therapeutic response by the nurse is:
A. “You are upset that it’s too late to visit places that you would like to see?”
B. “There are many people who feel exactly the same as you do.”
C. “Don’t worry. You can still visit all of the places that you would like to see.”
D. “I think you should visit the places you would like to see before it’s too late.”
____ 12. The nurse is caring for a patient who has just been diagnosed with a brain tumor. The patient asks the nurse if he should choose to have surgery. The nurse’s most therapeutic response is:
A. “Tell me what you know about surgery.”
B. “I would never decide against having surgery.”
C. “If I were you, I would definitely have the surgery.”
D. “Don’t worry. You will be fine if you don’t have surgery.”
____ 13. The nurse is caring for a patient who develops dyspnea that does not improve with oxygen therapy and nebulizer treatment. The nurse immediately calls the patient’s primary health care provider. This type of communication is called
A. Upward.
B. Bilateral.
C. Horizontal.
D. Downward.
____ 14. The nurse is caring for a patient who requires assistance with feeding. The nurse delegates this task to the certified nursing assistant (CNA). This type of communication is called
A. Upward.
B. Bilateral.
C. Horizontal.
D. Downward.
____ 15. The nurse observes a student nurse caring for a hearing-impaired patient. The nurse would intervene if the student nurse
A. Speaks clearly without shouting.
B. Speaks directly to the patient’s interpreter.
C. Positions himself or herself in front of the patient when speaking.
D. Turns down the radio volume when speaking to the patient.
____ 16. The nurse is caring for a patient who was admitted to the hospital for a cerebrovascular accident (CVA) resulting in difficulty understanding speech. The nurse recognizes that the patient is experiencing
A. Receptive aphasia.
B. Expressive aphasia.
C. Receptive dysphagia.
D. Expressive dysphagia.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 1. A nursing instructor is educating a class of nursing students about effective communication. The nursing instructor teaches that effective communication (select all that apply):
A. Is essential in proper documentation practices.
B. Is the foundation of nurse-patient relationships.
C. Helps establish proper transfer of health care information.
D. Is a vital component in building professional relationships.
E. Is something that nurses often feel prepared to do in clinical situations.
F. Is a key element when reporting information to other health care members.
____ 2. The nurse understands that when communicating with a patient face-to-face, communication is (select all that apply):
A. An active process.
B. As simple as telling.
C. As simple as informing.
D. A passive, one-sided event.
E. Completed when the receiver offers feedback.
F. Involves both parties sending and receiving messages simultaneously.
____ 3. When performing an admission assessment, the nurse assesses the patient’s verbal communication. The nurse recognizes that verbal communication includes (select all that apply):
A. The patient’s tense posture.
B. The patient’s written words.
C. The patient’s facial grimacing.
D. The patient’s verbal complaints.
E. The patient’s vocalization of pain.
F. The patient’s disheveled appearance.
____ 4. When performing an admission assessment, the nurse assesses the patient’s nonverbal communication. The nurse recognizes that nonverbal communication includes (select all that apply):
A. The patient’s rigid posture.
B. The patient’s written words.
C. The patient’s brow tightening.
D. The patient’s verbal complaints.
E. The patient’s manicured appearance.
F. The patient’s vocalization of anxiety.
____ 5. The nurse demonstrates active listening when (select all that apply):
A. Ignoring nonverbal cues.
B. Tuning out intrusions and distractions.
C. Using all of the senses to interpret verbal messages.
D. Paying attention to what the speaker is saying.
E. Using all of the senses to interpret nonverbal messages.
F. Paying attention to what the speaker is not saying.
____ 6. To complete the process of active listening, the nurse should (select all that apply):
A. Share perceptions.
B. Avoid confrontation.
C. Exhibit a superior attitude.
D. Refrain from sharing feelings.
E. Respond to the content heard in the message.
F. Provide feedback about understanding what was said.
____ 7. When communicating with a patient, the nurse recognizes that patient-centered communication is defined as communication that (select all that apply):
A. Is focused primarily on the nurse.
B. Empowers patients to participate in their care.
C. Encourages patients to participate in their care.
D. Discourages patients to participate in their care.
E. Discourages patients from participating in decisions.
F. Is essential to establishing a positive nurse-patient relationship.
____ 8. The nurse is caring for a patient with Wernicke’s aphasia. When communicating with the patient, the nurse should (select all that apply):
A. Speak slowly.
B. Speak rapidly.
C. Use long sentences.
D. Ask yes or no questions.
E. Avoid interrupting the patient.
F. Speak in a normal tone of voice.
Completion
Complete each statement.
The distance or personal space that people place between themselves and others is called _________.
Chapter 6. Communication and Relationships
Answer Section
MULTIPLE CHOICE
ANS: B
Feedback
A Verbal and nonverbal language should be congruent, or in agreement, to effectively meet the goal of shared meaning in communication.
B Verbal and nonverbal language should be congruent, or in agreement, to effectively meet the goal of shared meaning in communication. Chapter Objective: List the factors that influence communication.
C Verbal communication is more direct than nonverbal communication and is often used to give or receive specific information.
D Verbal and nonverbal language should be congruent, or in agreement, to effectively meet the goal of shared meaning in communication.
PTS: 1 REF: Chapter: 6 | Page: 117 OBJ: Chapter Objective: 6-2
KEY: Content Area: Verbal and NonVerbal and Nonverbal Communication | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: B
Feedback
A The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is public, which is 12 feet if possible.
B The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is intimate, which ranges from physical contact to 18 inches. Chapter Objective: List the factors that influence communication.
C The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is casual-personal, which ranges from 18 inches to 4 feet.
D The distance or personal space, people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is social-consultative, which ranges from 4 to 12 feet.
PTS: 1 REF: Chapter: 6 | Page: 117 OBJ: Chapter Objective: 6-2
KEY: Content Area: Personal Space-Distance Zones | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: C
Feedback
A The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is public, which is 12 feet if possible.
B The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is intimate, which ranges from physical contact to 18 inches.
C The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is casual-personal, which ranges from 18 inches to 4 feet. Chapter Objective: List the factors that influence communication.
D The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is social-consultative, which ranges from 4 to 12 feet.
PTS: 1 REF: Chapter: 6 | Page: 117 OBJ: Chapter Objective: 6-2
KEY: Content Area: Personal Space-Distance Zones | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: D
Feedback
A The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is public, which is 12 feet if possible.
B The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is intimate, which ranges from physical contact to 18 inches.
C The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is casual-personal, which ranges from 18 inches to 4 feet.
D The distance or personal space, people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is social-consultative, which ranges from 4 to 12 feet. Chapter Objective: List the factors that influence communication.
PTS: 1 REF: Chapter: 6 | Page: 117 OBJ: Chapter Objective: 6-2
KEY: Content Area: Personal Space-Distance Zones | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: A
Feedback
A The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is public, which is 12 feet if possible. Chapter Objective: List the factors that influence communication.
B The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is intimate, which ranges from physical contact to 18 inches.
C The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is casual-personal, which ranges from 18 inches to 4 feet.
D The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and it affects communication. Four personal space-distance zones have been identified for use in the United States. One of them is social-consultative, which ranges from 4 to 12 feet.
PTS: 1 REF: Chapter: 6 | Page: 117 OBJ: Chapter Objective: 6-2
KEY: Content Area: Personal Space-Distance Zones | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: D
Feedback
A A person’s body position will communicate messages in several ways. For example, when a nurse stands over and peers down at a seated patient, it may demonstrate the desire of the nurse to maintain some physical distance or to have a position of authority. This may be perceived quite rightly by the patient that the nurse is not really concerned and does not care to listen.
B Slumping body posture may indicate disinterest or boredom.
C Folded arms may indicate a resistance to hearing a message.
D To demonstrate a willingness to communicate effectively with patients, the nurse should communicate at eye level with the other person, lean slightly forward, and maintain an open body posture. Chapter Objective: List the factors that influence communication.
PTS: 1 REF: Chapter: 6 | Page: 117 OBJ: Chapter Objective: 6-2
KEY: Content Area: Communication | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: A
Feedback
A The passive or avoidant behavior style is characterized by the desire to avoid confrontation and the inability to share feelings or needs with others. Individuals with this communication style have trouble asking for help and allow others to take advantage of them, resulting in feelings of anger, emotional pain, and anxiety. Chapter Objective: Identify the preferred style of communication for nurses.
B Assertive communication is the most effective communication style for nurses to practice. An assertive style provides self-esteem and self-confidence and allows the nurse to care for others with a higher degree of commitment and respect.
C The aggressive behavior style is characterized by putting one’s own needs, rights, and feelings before those of others. Individuals with this behavior style exhibit a superior attitude; they try to humiliate others and communicate in an angry, hostile way that does not acknowledge the feelings of others.
D The aggressive behavior style is characterized by putting one’s own needs, rights, and feelings before those of others. Individuals with this behavior style exhibit a superior attitude; they try to humiliate others and communicate in an angry, hostile way that does not acknowledge the feelings of others. Demeaning falls under the category of aggressive behavior.
PTS: 1 REF: Chapter: 6 | Page: 119 OBJ: Chapter Objective: 6-5
KEY: Content Area: Styles of Communication | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: B
Feedback
A The passive or avoidant behavior style is characterized by the desire to avoid confrontation and the inability to share feelings or needs with others. Individuals with this communication style have trouble asking for help and allow others to take advantage of them, resulting in feelings of anger, emotional pain, and anxiety.
B Assertive communication is the most effective communication style for nurses to practice. An assertive style provides self-esteem and self-confidence and allows the nurse to care for others with a higher degree of commitment and respect. Chapter Objective: Identify the preferred style of communication for nurses.
C The aggressive behavior style is characterized by putting one’s own needs, rights, and feelings before those of others. Individuals with this behavior style exhibit a superior attitude; they try to humiliate others and communicate in an angry, hostile way that does not acknowledge the feelings of others.
D The aggressive behavior style is characterized by putting one’s own needs, rights, and feelings before those of others. Individuals with this behavior style exhibit a superior attitude; they try to humiliate others and communicate in an angry, hostile way that does not acknowledge the feelings of others. Demeaning falls under the category of aggressive behavior.
PTS: 1 REF: Chapter: 6 | Page: 119 OBJ: Chapter Objective: 6-5
KEY: Content Area: Styles of Communication | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: D
Feedback
A The passive or avoidant behavior style is characterized by the desire to avoid confrontation and the inability to share feelings or needs with others. Individuals with this communication style have trouble asking for help and allow others to take advantage of them, resulting in feelings of anger, emotional pain, and anxiety.
B The passive or avoidant behavior style is characterized by the desire to avoid confrontation and the inability to share feelings or needs with others. Individuals with this style have trouble asking for help and allow others to take advantage of them, resulting in feelings of anger, emotional pain, and anxiety.
C Assertive communication is the most effective communication style for nurses to practice. An assertive style provides self-esteem and self-confidence and allows the nurse to care for others with a higher degree of commitment and respect.
D The aggressive behavior style is characterized by putting one’s own needs, rights, and feelings before those of others. Individuals with this behavior style exhibit a superior attitude; they try to humiliate others and communicate in an angry, hostile way that does not acknowledge the feelings of others. Chapter Objective: Identify the preferred style of communication for nurses.
PTS: 1 REF: Chapter: 6 | Page: 119 OBJ: Chapter Objective: 6-5
KEY: Content Area: Styles of Communication | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: C
Feedback
A The passive or avoidant behavior style is characterized by the desire to avoid confrontation and the inability to share feelings or needs with others. Individuals with this communication style have trouble asking for help and allow others to take advantage of them, resulting in feelings of anger, emotional pain, and anxiety.
B The passive or avoidant behavior style is characterized by the desire to avoid confrontation and the inability to share feelings or needs with others. Individuals with this style have trouble asking for help and allow others to take advantage of them, resulting in feelings of anger, emotional pain, and anxiety.
C Assertive communication is the most effective communication style for nurses to practice. An assertive style provides self-esteem and self-confidence and allows the nurse to care for others with a higher degree of commitment and respect. Chapter Objective: Identify the preferred style of communication for nurses.
D The aggressive behavior style is characterized by putting one’s own needs, rights, and feelings before those of others. Individuals with this behavior style exhibit a superior attitude; they try to humiliate others and communicate in an angry, hostile way that does not acknowledge the feelings of others.
PTS: 1 REF: Chapter: 6 | Page: 119 OBJ: Chapter Objective: 6-5
KEY: Content Area: Styles of Communication | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Application
ANS: A
Feedback
A This is an example of the therapeutic response of reflection, in which the nurse reflects the same words back to the patient, which encourages verbalization of feelings. Chapter Objective: Compare therapeutic communication techniques with communication barriers.
B This is an example of the nontherapeutic response of belittling a patient’s feelings.
C This is an example of the nontherapeutic response of giving false reassurance.
D This is an example of the nontherapeutic response of giving advice.
PTS: 1 REF: Chapter: 6 | Page: 120 OBJ: Chapter Objective: 6-4
KEY: Content Area: Therapeutic Communication | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: A
Feedback
A This is an example of the therapeutic response of an open-ended statement that encourages elaboration and discourages answering questions with one or two words. Chapter Objective: Compare therapeutic communication techniques with communication barriers.
B This is an example of the nontherapeutic response of expressing disapproval.
C This is an example of the nontherapeutic response of giving advice.
D This is an example of the nontherapeutic response of giving false reassurance.
PTS: 1 REF: Chapter: 6 | Page: 120 OBJ: Chapter Objective: 6-4
KEY: Content Area: Therapeutic Communication | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: A
Feedback
A Upward communication is the interaction with those in authority over an individual and is formal by nature. The terms upward and downward communication refer to placement on an organizational chart. Chapter Objective: Discuss effective methods of communication with the health care team.
B Upward communication is the interaction with those in authority over an individual and is formal by nature. The terms upward and downward communication refer to placement on an organizational chart.
C Upward communication is the interaction with those in authority over an individual and is formal by nature. The terms upward and downward communication refer to placement on an organizational chart.
D Upward communication is the interaction with those in authority over an individual and is formal by nature. The terms upward and downward communication refer to placement on an organizational chart.
PTS: 1 REF: Chapter: 6 | Page: 121 OBJ: Chapter Objective: 6-7
KEY: Content Area: Upward Communication | Integrated Process: Communication | Client Need: Safe and Effective Care Environment | Cognitive Level: Application
ANS: D
Feedback
A Upward communication is the interaction with those in authority over an individual and is formal by nature. Nurses provide direction to and supervise other licensed and unlicensed assistive personnel. Communicating with those whom one supervises is called downward communication. The terms upward and downward communication refer to placement on an organizational chart.
B Upward communication is the interaction with those in authority over an individual and is formal by nature. Nurses provide direction to and supervise other licensed and unlicensed assistive personnel. Communicating with those whom one supervises is called downward communication. The terms upward and downward communication refer to placement on an organizational chart.
C Upward communication is the interaction with those in authority over an individual and is formal by nature. Nurses provide direction to and supervise other licensed and unlicensed assistive personnel. Communicating with those whom one supervises is called downward communication. The terms upward and downward communication refer to placement on an organizational chart.
D Upward communication is the interaction with those in authority over an individual and is formal by nature. Nurses provide direction to and supervise other licensed and unlicensed assistive personnel. Communicating with those whom one supervises is called downward communication. The terms upward and downward communication refer to placement on an organizational chart. Chapter Objective: Discuss effective methods of communication with the health care team.
PTS: 1 REF: Chapter: 6 | Page: 123 OBJ: Chapter Objective: 6-7
KEY: Content Area: Downward Communication | Integrated Process: Communication | Client Need: Safe and Effective Care Environment | Cognitive Level: Application
ANS: B
Feedback
A Communication with patients who are hearing impaired requires the nurse to speak clearly, with adequate volume, and without shouting or mumbling.
B Caregivers should speak to the patient, not the interpreter, if there is one present. Chapter Objective: Identify effective communication techniques for patients with special needs.
C Caregivers should position themselves in front of the patient so that the patient can see their lips.
D Caregivers should eliminate background noise, such as by turning down the television or other distractions, when communicating with a hearing-impaired patient.
PTS: 1 REF: Chapter: 6 | Page: 127 OBJ: Chapter Objective: 6-9
KEY: Content Area: Special Communication Needs | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: A
Feedback
A Aphasia is a general term for a dysfunction in language. A patient may have trouble processing language output, known as expressive aphasia, or may have difficulty understanding speech, known as receptive aphasia. Chapter Objective: Identify effective communication techniques for patients with special needs.
B Aphasia is a general term for a dysfunction in language. A patient may have trouble processing language output, known as expressive aphasia, or may have difficulty understanding speech, known as receptive aphasia.
C Aphasia is a general term for a dysfunction in language. A patient may have trouble processing language output, known as expressive aphasia, or may have difficulty understanding speech, known as receptive aphasia.
D Aphasia is a general term for a dysfunction in language. A patient may have trouble processing language output, known as expressive aphasia, or may have difficulty understanding speech, known as receptive aphasia.
PTS: 1 REF: Chapter: 6 | Page: 128 OBJ: Chapter Objective: 6-9
KEY: Content Area: Receptive Aphasia | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Application
MULTIPLE RESPONSE
ANS: A, B, C, D, F
Feedback: Effective communication is essential in proper documentation practices, is the foundation of nurse-patient relationships, helps establish the proper transfer of health care information, and is a key element when reporting information to other health care members—all vital components of building relationships and carrying out professional responsibilities of caring for others. Despite the importance of effective communication, surveys tell us that nurses often feel unprepared for the wide range of communication skills that are necessary in clinical settings. Chapter Objective: Describe the communication process.
PTS: 1 REF: Chapter: 6 | Page: 116 OBJ: Chapter Objective: 6-1
KEY: Content Area: Effective Communication | Integrated Process: Communication | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis
ANS: A, E, F
Feedback: When people are face-to-face, communication is an active process that involves informing, or sending, and receiving, which includes listening, observing, processing, and comprehending in a reciprocal fashion. To complete the communication process, the receiver will send feedback, or a return message, that indicates that the message has been received, processed, and comprehended. In face-to-face interactions, both parties will send and receive messages simultaneously, by interpreting the words spoken and the tone, body language, and inflection of the voice. Chapter Objective: Describe the communication process.
PTS: 1 REF: Chapter: 6 | Page: 116 OBJ: Chapter Objective: 6-1
KEY: Content Area: Face-to-Face Communication | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: B, D, E
Feedback: Verbal communication is a conscious use of words, either spoken or written. Nonverbal communication is conveyed by body language—facial expressions, posture, body position, behavior, gestures, touch, and general appearance. Chapter Objective: Describe the communication process.
PTS: 1 REF: Chapter: 6 | Page: 116 OBJ: Chapter Objective: 6-1
KEY: Content Area: Verbal and Nonverbal Communication | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: A, C, E
Feedback: Nonverbal communication is conveyed by body language—facial expressions, posture, body position, behavior, gestures, touch, and general appearance. Verbal communication is a conscious use of words, either spoken or written. Chapter Objective: Describe the communication process.
PTS: 1 REF: Chapter: 6 | Page: 116 OBJ: Chapter Objective: 6-1
KEY: Content Area: Verbal and Nonverbal Communication | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: B, C, D, E, F
Feedback: It takes practice for the mind to tune out other intrusions and distractions, to focus on the speaker, and then to wait for the entire message to be delivered before interpreting what is said. Active listening techniques use all of the senses to interpret verbal and nonverbal messages. In active listening, attention is paid to what the speaker is saying, but also to what is not said. Chapter Objective: Describe the term active listening.
PTS: 1 REF: Chapter: 6 | Page: 118 OBJ: Chapter Objective: 6-3
KEY: Content Area: Active Listening | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: A, E, F
Feedback: To complete the process of active listening, the nurse should respond to the content heard in the message, share his or her perceptions, and state as feedback what he or she, as the listener, understood was said by the speaker. The passive or avoidant behavior style is characterized by the desire to avoid confrontation and the inability to share feelings or needs with others. Individuals with this style have trouble asking for help and allow others to take advantage of them, resulting in feelings of anger, emotional pain, and anxiety. The aggressive behavior style is characterized by putting one’s own needs, rights, and feelings before those of others. Individuals with this behavior style exhibit a superior attitude; they try to humiliate others and communicate in an angry, hostile way that does not acknowledge the feelings of others. Chapter Objective: Describe the term active listening.
PTS: 1 REF: Chapter: 6 | Page: 118 OBJ: Chapter Objective: 6-3
KEY: Content Area: Active Listening | Integrated Process: Communication | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
ANS: B, C, F
Feedback: Patient-centered communication has been defined as communication that encourages and empowers patients to participate in their care; it is focused on the patient and is an essential component to establishing a positive nurse-patient relationship. Chapter Objective: Define the term empathy and its role in patient-centered communication.
PTS: 1 REF: Chapter: 6 | Page: 126 OBJ: Chapter Objective: 6-8
KEY: Content Area: Patient-Centered Communication | Integrated Process: Communication | Client Need: Safe and Effective Care Environment | Cognitive Level: Analysis
ANS: A, D, E, F
Feedback: Receptive aphasia (Wernicke’s aphasia) is a deficit in auditory comprehension or with receiving information. The patient can hear, but cannot understand what is said, may be slow to respond, or may only understand a portion of what is said. When communicating with patients with aphasia, the nurse should speak slowly and in a normal tone of voice, ask yes or no questions, and avoid interrupting the patient. Chapter Objective: Identify effective communication techniques for patients with special needs.
PTS: 1 REF: Chapter: 6 | Page: 128 OBJ: Chapter Objective: 6-9
KEY: Content Area: Aphasia | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Analysis
COMPLETION
ANS:
proxemics
Feedback: The distance or personal space that people place between themselves and others is called proxemics. It reflects feelings and attitudes, and affects communication. Chapter Objective: List the factors that influence communication.
PTS: 1 REF: Chapter: 6 | Page: 117 OBJ: Chapter Objective: 6-2
KEY: Content Area: Proxemics | Integrated Process: Caring | Client Need: Psychosocial Integrity | Cognitive Level: Comprehension
Chapter 7. Promoting Health and Wellness
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. The nurse explains to the patient that health is measured on a continuum scale and that
A. It proves that health is constant and rarely fluctuates.
B. The higher the measurement is, the better one’s health is.
C. It measures only the physical aspects of health.
D. It would be more accurate if mental and emotional aspects could be measured.
____ 2. A male patient with severe chronic obstructive pulmonary disease (COPD) was brought to the hospital by emergency personnel. He lives alone, has no relatives or friends living nearby, and lives on a fixed income, which prevents him from purchasing all of the medications that he needs. Based on Dunn’s wellness grid, the nurse determines that the quadrant that the patient is in is
A. High-level wellness in a favorable environment.
B. Emergent high-level wellness in an unfavorable environment.
C. Protected poor health in a favorable environment.
D. Poor health in an unfavorable environment
____ 3. The nurse educator explains to student nurses Fitzpatrick’s rhythm model theory. According to this theory, the patient’s health
A. Is only a state of mind over matter and is controlled by the patient.
B. Is always changing and fluctuates throughout four wellness quadrants.
C. Defines how well the individual promotes his or her physical well-being.
D. Is the result of the interaction between an individual and the environment.
____ 4. The nurse discusses with the patient ways to improve health and prevent disease. The nurse suggests that the patient
A. Use emergency and urgent care facilities for routine care.
B. Worry less about food groups and more about calories.
C. Eliminate certain food groups from the diet.
D. Participate in stress-management techniques.
____ 5. The nurse educates the patient in ways to prevent long-term illnesses or diseases. The nurse states,
A. “It is important that you receive the flu vaccination every year.”
B. “Your diet should be moderate in calories and include a variety of foods.”
C. “Running at least 4 to 5 miles per day will ensure that you do not develop cancers or heart diseases.”
D. “Smoking cigarettes that are low in tar and nicotine will greatly decrease your risk of developing respiratory problems.”
____ 6. A patient being seen in the clinic tells the nurse, “The pain is in my right side.” The patient’s phase of illness is
A. Prodromal.
B. Symptomatic.
C. Seeking help.
D. Dependency.
____ 7. The nurse instructs the patient, “You can decrease your risks for developing many diseases and illnesses by developing healthy habits and participating in health screenings.” The patient validates understanding when he or she states,
A. “As long as I begin to limit the amount of bad carbohydrates in my diet and begin exercising by the age of 50, I probably will not develop type 2 diabetes.”
B. “Performing monthly breast self-exams if I have a family history of breast cancer will decrease my chances of developing it.”
C. “I can take responsibility for reducing risks by eating a well-balanced diet and seeing my primary care physician for routine health screenings.”
D. “Since I am at risk for developing high cholesterol, it will be important for me to ask my primary care physician for medications to prevent it.”
____ 8. The patient told the nurse, “I can’t remember anything right before or after my wreck, but the officer told me that I left lots of black marks trying to stop.” The nurse explains to the patient,
A. “When scared, the parasympathetic system stimulates the fight-or-flight response.”
B. “Your fight-or-flight response pumps adrenaline into your system, which enhances your ability to react quickly.”
C. “Cortisol, a natural hormone, ceases production and, as a result, we are able to respond quickly in an emergency.”
D. “The sympathetic nervous system blocks your endocrine glands, resulting in additional hormones enabling a quick response.”
____ 9. A patient who is admitted for observation following an episode of chest pain relieved by rest and two nitroglycerin tabs, tells the nurse that his job as CEO of a large firm is becoming too much to handle. According to Selye, the nurse suspects that the patient most likely is experiencing
A. An interaction between the individual and the environment.
B. Protected poor health in a favorable environment.
C. The seeking help phase of illness.
D. The exhaustion phase of stress.
____ 10. A 42-year-old female patient who was just admitted states, “I must be under too much stress. I just do not feel well.” The nurse understands that her complaint could be a symptom of stress and is not surprised to find that
A. Her blood pressure is 178/96.
B. She sets aside some time each day to relax.
C. Her pupils are constricted and reactive to light.
D. She is limiting fats and sugar in her diet.
____ 11. The elderly patient with a history of congestive heart failure was just admitted for chest pain. The patient asks the nurse, “Why did my chest pain begin after I thought someone was trying to break into my house?” The best response by the nurse is:
A. “Response to fear increases the body’s demand for oxygen, which can place additional stress on your damaged heart and cause chest pain.”
B. “The parasympathetic system used all of your available adrenaline, leaving you so tired that you developed chest pain.”
C. “Because the release of cortisol blocks the body’s response to fear, you weren’t allowed sufficient time rest, which can cause chest pain.”
D. “The decrease in oxygen utilization during the fight-or-flight response is most likely the reason that you developed chest pain.”
____ 12. The nurse educator explains to student nurses that according to Selye, the general adaptation syndrome, or GAS, is
A. An explanation of how the body’s response to stress prevents death.
B. Validated by how many people are struggling with terminal illnesses, such as cancer.
C. A theory explaining the body’s attempt to adjust to stress.
D. What prevents the threat to health when there is long-term stress.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 1. A nurse encourages a patient to be proactive in promoting and maintaining health by (select all that apply):
A. Introducing the patient to the benefits of a regular exercise program.
B. Discussing the obvious and hidden dangers of drug and alcohol abuse.
C. Referring an uninsured patient to a facility that allows payment plans.
D. Suggesting that medical care is accessed in acute emergencies and that alternative forms of treatment are used when it is not.
E. Explaining the importance of obtaining required immunizations for children.
____ 2. The nurse explains to the patient that Healthy People 2010 was established by the Office of Disease Prevention and Health Promotions to (select all that apply):
A. Fund exercise programs in businesses.
B. Increase quality of life and longevity.
C. Force tobacco companies to close.
D. Eliminate disparities in health issues.
E. Legally require obese individuals to lose weight.
____ 3. During a discussion with a patient participating in a health screening, the nurse suggests positive ways to cope with stress, such as (select all that apply):
A. Relaxing with family and friends.
B. Accepting all challenges.
C. Saying no when one has other obligations.
D. Eating a diet high in fat and carbohydrates.
E. Getting rid of excessive possessions.
____ 4. A patient, recently terminated at his place of employment, has been admitted to the hospital via the emergency room. He smokes approximately two packs of cigarettes and drinks approximately a six-pack of beer daily, and he states that he exercises three times a week for 30 minutes. According to Healthy People 2010, the nurse identifies the indicators that place the patient at risk for illness as (select all that apply):
A. Tobacco use.
B. Substance abuse.
C. Environmental quality.
D. Access to health care.
E. Physical activity.
Chapter 7. Promoting Health and Wellness
Answer Section
MULTIPLE CHOICE
ANS: B
Feedback
A Well-being and health may fluctuate during any given day; the continuum does not prove that health is constant.
B The more positive the physical and mental aspects of a person are, the higher the rating is on the scale. Chapter Objective: Explain the wellness-illness continuum.
C Both the mental and physical health of an individual are measured and rated on the continuum.
D Mental and emotional aspects, as well as physical aspects, are measured.
PTS: 1 REF: Chapter: 7 | Page: 134 OBJ: Chapter Objective: 7-2
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Health Promotion/Screening Programs | Cognitive Level: Application
ANS: D
Feedback
A Individuals in this quadrant are healthy and implement healthy lifestyle behaviors.
B In this quadrant are individuals who are healthy and understand behaviors to promote health, but who do not take the time or have the motivation to implement healthy lifestyle behaviors.
C In this quadrant are individuals who are ill but have good support systems in place.
D In this quadrant are individuals with life-threatening diseases; poor or nonexistent support systems; and no access to appropriate medications, diet, and health-care instruction. Chapter Objective: Describe two theories of wellness and illness.
PTS: 1 REF: Chapter: 7 | Page: 134 OBJ: Chapter Objective: 7-3
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Communication and Documentation | Client Need: Health Promotion and Maintenance/Data Collection Techniques | Cognitive Level: Analysis
ANS: D
Feedback
A Fitzpatrick’s theory is based on four concepts: the whole person, health, wellness-illness, and transitions.
B Dunn’s theory of wellness involves four wellness quadrants.
C According to Fitzpatrick, health changes continuously throughout a person’s lifetime, responding to his or her interaction with the environment.
D Fitzpatrick’s theory teaches that health is a result of an individual’s interaction with his or her environment. Chapter Objective: Describe two theories of wellness and illness.
PTS: 1 REF: Chapter: 7 | Page: 135 OBJ: Chapter Objective: 7-3
KEY: Content Area: Coordinated Care | Integrated Process: Teaching and Learning | Client Need: Safe and Effective Care Environment/Coordinated Care/Staff Education | Cognitive Level: Comprehension
ANS: D
Feedback
A Routine medical care is encouraged to promote health and wellness. Emergency and urgent care are utilized for acute care.
B Diet should be in moderation, pertaining to food groups and calories.
C A balanced diet promotes health and should include foods from each food group.
D Too much stress impacts health; learning to manage stress improves health. Chapter Objective: Identify risk factors for selected illnesses.
PTS: 1 REF: Chapter: 7 | Page: 140 OBJ: Chapter Objective: 7-6
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Health Promotion/Screening Programs | Cognitive Level: Application
ANS: B
Feedback
A Getting the flu vaccination annually does protect against the flu and its complications, but influenza is not a chronic illness.
B Eating a well-balanced diet with moderate calories protects against diabetes mellitus, gastric cancers, and many other long-term illnesses. Chapter Objective: Identify risk factors for selected illnesses.
C Moderate exercise will help protect an individual from developing illnesses or diseases; however, running 4 to 5 miles per day is not moderate exercise, nor will it ensure that a person will not develop diseases.
D Smoking can harm one’s health whether or not cigarettes are low in tar and nicotine.
PTS: 1 REF: Chapter: 7 | Page: 139 OBJ: Chapter Objective: 7-6
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Health Promotion/Screening Programs | Cognitive Level: Application
ANS: C
Feedback
A In the prodromal phase of illness, there are no specific symptoms of an illness; there are only vague symptoms, such as body aches.
B In the symptomatic phase, the patient develops the symptoms of the specific illness that he or she is experiencing, but the patient hasn’t sought medical expertise yet.
C In the seeking help phase, the patient seeks help from a medical care provider; the patient’s contact with the health care provider includes data being collected by the nurse. Chapter Objective: Define key terms related to health promotion and illness.
D In the dependency phase, the patient requires diagnosis and/or treatment; the patient may also require others’ assistance with work or family duties.
PTS: 1 REF: Chapter: 7 | Page: 139 OBJ: Chapter Objective: 7-1
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Nursing Process/Assessment | Client Need: Health Promotion and Maintenance/Data Collection Techniques | Cognitive Level: Analysis
ANS: C
Feedback
A Associating modifications with a particular age does not demonstrate understanding of an individual’s responsibility in reducing risks of developing illness/disease.
B Monthly breast self-examinations are encouraged to promote early detection of breast cancer, not prevention, and should be routine whether or not breast cancer runs in an individual’s family.
C Identifying an individual’s responsibility to eat a well-balanced diet and participate in routine health screenings demonstrates understanding of how to reduce his or her risks of developing illnesses/diseases. Chapter Objective: Identify risk factors for selected illnesses.
D Seeking medication to prevent risk, rather than making modifications in diet and lifestyle, does not indicate a patient’s understanding.
PTS: 1 REF: Chapter: 7 | Page: 139 OBJ: Chapter Objective: 7-6
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Health Promotion/Screening Programs | Cognitive Level: Application
ANS: B
Feedback
A When frightened, it is the sympathetic nervous system that responds.
B Adrenaline, cortisol, and other hormones are released as a result of the fight-or-flight response. Chapter Objective: Describe the body’s reactions during the “fight-or-flight” response.
C When faced with an emergency, cortisol production is increased.
D The sympathetic nervous system stimulates, rather than blocks, your endocrine glands.
PTS: 1 REF: Chapter: 7 | Page: 140 OBJ: Chapter Objective: 7-9
KEY: Content Area: Physiological Adaptation | Integrated Process: Teaching and Learning | Client Need: Physiological Integrity/Physiological Adaptation/Alterations in Body Systems | Cognitive Level: Application
ANS: D
Feedback
A Interaction between the individual and environment is Fitzpatrick’s rhythm model theory.
B Protected poor health in a favorable environment is one of the quadrants of Dunn’s theory.
C Seeking help is a phase of illness, not Selye’s theory of stress and illness.
D According to Selye, when the body can no longer keep up with the effects of stress, it leaves an individual vulnerable to physical and psychological disease. Chapter Objective: Define stress and adaptation.
PTS: 1 REF: Chapter: 7 | Page: 140 OBJ: Chapter Objective: 7-7
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Nursing Process/Assessment | Client Need: Health Promotion and Maintenance/Data Collection Techniques | Cognitive Level: Analysis
ANS: A
Feedback
A A sign of stress is an elevated blood pressure. Chapter Objective: Describe the symptoms of stress.
B Setting aside some time each day to relax would have a positive influence over stress and help to prevent signs of stress.
C When stressed, pupils will dilate; constricted pupils are not indicative of stress.
D Limiting fats and sugar from one’s diet would have a positive effect on stress.
PTS: 1 REF: Chapter: 7 | Page: 141 OBJ: Chapter Objective: 7-8
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Nursing Process/Assessment | Client Need: Health Promotion and Maintenance/Data Collection Techniques | Cognitive Level: Analysis
ANS: A
Feedback
A During the fight-or-flight response, increased oxygen is needed and glucose is burned faster to provide energy to respond to the situation, which places unneeded stress on an already-weakened heart muscle. Chapter Objective: Describe the body’s reactions during the “fight-or-flight” response.
B The parasympathetic system blocks the release of adrenaline.
C The release of cortisol fuels the body’s response to fear.
D During the fight-or-flight response, there is an increase in oxygen utilization.
PTS: 1 REF: Chapter: 7 | Page: 140 OBJ: Chapter Objective: 7-11
KEY: Content Area: Physiological Adaptation | Integrated Process: Teaching and Learning | Client Need: Physiological Integrity/Physiological Adaptation/Alterations in Body Systems | Cognitive Level: Analysis
ANS: C
Feedback
A GAS identifies how chronic unrelieved stress can result in an individual’s premature death.
B Terminal illnesses have various reasons for occurring and not all are caused by stress.
C GAS is a theory explaining how our body responds to short- and long-term stress. Chapter Objective: Define stress and adaptation.
D GAS allows the body to adapt to long-term stress but does not prevent a threat to health.
PTS: 1 REF: Chapter: 7 | Page: 140 OBJ: Chapter Objective: 7-7
KEY: Content Area: Coordinated Care | Integrated Process: Teaching and Learning | Client Need: Safe and Effective Care Environment/Coordinated Care/Staff Education | Cognitive Level: Comprehension
MULTIPLE RESPONSE
ANS: A, B, C, E
Feedback: Participating in physical exercise, preventing or recognizing substance abuse, having access to medical care, and keeping immunizations current promote health. Medical care should also be accessed for annual exams, illness, and so on. Chapter Objective: Identify risk factors for selected illnesses.
PTS: 1 REF: Chapter: 7 | Page: 136 OBJ: Chapter Objective: 7-6
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Health Promotion/Screening Programs | Cognitive Level: Application
ANS: B, D
Feedback: The goals of Healthy People 2010 are to improve quality and years of life and to eliminate health disparities. Healthy People 2010 encourages exercise but does not fund exercise programs, encourages the cessation of smoking but not the closure of tobacco companies, and encourages weight loss but was not established to require it. Chapter Objective: Identify the two goals of Healthy People 2010.
PTS: 1 REF: Chapter: 7 | Page: 135 OBJ: Chapter Objective: 7-4
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Health Promotion/Screening Programs | Cognitive Level: Comprehension
ANS: A, C, E
Feedback: Relaxing with family and friends, learning to say no, and ridding self of clutter are positive coping strategies. Challenges can be positive, but too many increase stress. Eat a well-balanced diet and avoid fat and sugar. Carbohydrates should be complex. Chapter Objective: Categorize coping strategies in response to stress.
PTS: 1 REF: Chapter: 7 | Page: 141 OBJ: Chapter Objective: 7-10
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Health Promotion/Screening Programs | Cognitive Level: Application
ANS: A, B, D
Feedback: Indicators identifying health risks are tobacco use, drinking a six-pack of beer daily, and loss of employment where health insurance is typically provided; these indicators will likely limit an individual’s access to health care. Environmental quality pertains to quality of air, food production, and water, as well as chemical, biological, and physical agents that threaten an individual’s health. A history of regular physical exercise is not an indicator. Chapter Objective: Enumerate the 10 Leading Health Indicators of Healthy People 2010.
PTS: 1 REF: Chapter: 7 | Page: 136 OBJ: Chapter Objective: 7-5
KEY: Content Area: Health Promotion and Maintenance | Integrated Process: Teaching and Learning | Client Need: Health Promotion and Maintenance/Disease Prevention | Cognitive Level: Application
