Questions That Require Priority Setting Guidelines for establishing priorities are as follows:
• The nurse should always assess (gather pertinent data) before deciding on and taking an action. This is reflected in the steps of the Nursing Process: assess, diagnose, plan, intervene, and evaluate.
• Physiological needs must be met first. The client must be kept alive for anything else to be important. Next in importance are safety needs and then come psychological needs. This is outlined in Maslow’s hierarchy.
• When prioritizing physiological needs remember your ABCs: airway, breathing, and circulation.
• Which answer will keep the client safe/prevent client harm? It is especially relevant when the question deals with laboratory values, drug administration, and nursing procedures.
• Assessment of equipment never takes precedence over assessment of the client.
Communication Questions
Therapeutic communication promotes expression of feelings and ideas and also conveys acceptance and respect. Like any communication, it involves both verbal and nonverbal components.
Major techniques to facilitate therapeutic communication are as follows:
• Communicate in an accepting and respectful manner. Address (refer to) the client by his/her given name—not by a nickname, a room number, or “sweetie.” Names other than the given name should only be used upon the client’s request or permission. Clients should be asked, not told, whenever appropriate. This allows for client decision making and hence communicates respect for the client as an able, intelligent individual.
Examples:
What would you like to do first?
What would you like to talk about?
• Use open-ended questions. These are questions that cannot be answered with a Yes or a No.
Examples:
What do you think about this plan?
What questions do you have?
How do you feel about going home tomorrow?
Tell me about your headaches.
• Reflect feelings expressed by the client. Remember that feelings are expressed verbally and nonverbally. These may be contradictory but feelings expressed nonverbally are usually true because nonverbal communication is harder to control. Reflection indicates empathy, allows validation of the perceived feelings, and allows the client to “look at” his/her feelings. Words used in reflection should be neutral unless the client uses an emotionally charged word.
Examples:
You seem sad.
You seem unsure.
You must feel lonely sometimes.
I get the feeling you are upset.
Do not say:
You are depressed.
You can’t make a decision.
It must be awful being alone all the time.
You must be really mad at your neighbor.
• Focus the conversation on important areas.
Examples:
Let’s talk a little more about . . .
You were talking about the problem you had with changing
your dressing, let’s go back and explore that further.
• Paraphrase or restate what the client has said in your own words. This allows the client to validate the message or correct misunderstanding.
Examples:
What you are saying is . . .
Let me make sure I understand . . .
What I hear you saying is . . .
• Summarize the communication.
Therapeutic communication also involves (a) active listening, (b) stating observations made about the client but never any that would embarrass or anger the client (“You look rested” or “You seem quiet today.” Not “You look terrible.”), (c) reflecting empathy or an understanding of the importance of a situation to the client in a neutral, nonjudgmental manner (“It must be very disheartening . . .”), (d) sharing hope, humor, and feelings, (e) using touch and silence, (f ) asking pertinent questions, and (g) giving information. Nontherapeutic (blocking) communication techniques hinder further communication and expression of feelings and may induce negative responses. Some examples of nontherapeutic communication techniques are:
• Asking unnecessary personal questions: “Why are you just living with Mary rather than marrying her?” “Why are you still living at home?” “How come you haven’t bought a house?”
• Giving personal advice or opinions: “If I were you I would make my son move out.” “I think you should stop cooking for the whole family.”
• Flip or automatic responses, use of cliches: “Everything will work out.” “Don’t worry.” “It happens all the time but it doesn’t mean anything.” Redirecting the conversation or changing the subject, expressing sympathy, asking “why,” verbalizing approval or disapproval, responding defensively, passively or aggressively, and arguing also block therapeutic communication. When answering a communication question, begin by reviewing the above principles. Then determine what the question is asking. If the question is asking what is the nurse’s best response, what is the most appropriate response, what is the most therapeutic response, or what response will best support a therapeutic relationship, eliminate nontherapeutic options. Do this by identifying options that involve nontherapeutic responses: options that give opinions, options that brush off the client’s concerns; options that contain emotionally charged, defensive, accusatory, or otherwise upsetting or offensive wording, and options that contain judgmental wording.
Example:
A client who has been hospitalized for 2 weeks says to the nurse “I can’t stay here anymore, I have to get back to my family.” Which is the most appropriate response for the nurse to make?
a. “Don’t worry. Your family will be fine.”
b. “If I were you, I’d take advantage of the rest you’re getting while away from the family.”
c. “Would you like to talk about how you feel?” Correct
d. “Is your family unable to get along without you?”
In some cases, the question may be asking you to identify the nontherapeutic or inappropriate response. Be alert for this when reading questions and then select the option containing a response that would be incorrect for the nurse to make as the answer.
Example:
A client states “My family doesn’t seem to understand my illness.” Which response on the part of the nurse would most likely block further discussion?
a. “They may not seem to, but I’m sure they do.” Correct
b. “In what way do they react to give you that feeling?”
c. “Your family doesn’t seem to understand.”
d. “What makes you think that?”
Client-Teaching Questions
There are different types of client-teaching questions. Some are very straightforward simply asking what should the nurse teach. This type of question addresses the planning or
mplementation phase of the nursing process.
Example:
Which instruction/information should the nurse include in the teaching plan for a client with genital herpes? Which instruction/information should the nurse give to a client with genital herpes? A variation on this type of question asks you to identify not what needs to be taught but when or by whom, teaching is needed.
Example:
Which client should be taught about the need for potassium in the daily diet?
a. Client taking daily NSAIDS for arthritis
b. Client taking Toprol XL daily for hypertension
c. Client taking Fosamax weekly for osteoporosis
d. Client taking Hydrodiuril daily for fluid retention
Correct
Other client-teaching questions ask not what should be taught but how does the nurse know the teaching was
understood. These are client-teaching questions that address the evaluation phase of the nursing process. Was the teaching effective? Did the client learn? These questions may be phrased in a positive or negative way. Positive questions ask you to select an answer that is a correct statement or activity—something that should be done or said.
Examples of positively phrased questions: Which statement made by a client with hepatitis B following discharge teaching indicates that instruction was effective?
Which statement made by a client with hepatitis B indicates that discharge instructions were understood?
Negatively phrased questions ask you to identify the answer that indicates the client does not know, has misunderstood, or has not learned. It requires that you identify an incorrect statement—not a correct one. Negative questions require that you choose from the options the one that is incorrect or should not be said or done. Note that negative questions do not necessarily have a negative word (not, no, incorrect, etc.) in the stem.
Examples of negatively phrased questions:
Which statement made by a client taking Fosamax once a week for the treatment of osteoporosis indicates that the directions for taking the medication were not understood?
Which action taken by a client who has been taught to self-administer insulin indicates that further teaching/ instruction is necessary?
Which statement made by the mother of a child diagnosed with bronchiolitis indicates a need for teaching?
A client’s daughter is assisting her to the bathroom.
Which observation by the nurse suggests that teaching is needed?
Delegation Questions
These typically ask what duties can be assigned to a nurse aide or an LPN/LVN and when a physician, social worker, respiratory therapist, or other member of the health-care
team should be notified or consulted.
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