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Communication is the art of being able to structure and transmit a message in a way that another can understand easily and accept.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 111
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. Unspoken affective or expressive behaviors best describe which type of communication?
a. Effective communication
b. Ineffective communication c. Nonverbal communication d. Verbal communication
ANS: C
Nonverbal communication is unspoken. It is composed of affective or expressive behaviors. The effectiveness of verbal communication depends on vocabulary, language, phrases, sentence structure, sentence clarity, rate of speech, diction, tone, rhythm, and volume. Nonverbal behavior includes gestures, facial expression, eye contact, body language, and positioning (Hersey et al., 2008).
DIF: Cognitive Level: Understand (Comprehension) REF: Page 112
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. A nursing theory used to describe the manner of communicating that acknowledges the unique characteristics of the holistic human being is the:
a. Humanizing Nursing Communication Theory (HNCT).
b. situation, background, assessment, and recommendation (SBAR) Communication
Theory.
c. Behavioral System Model.
d. Human Relationship Model.
ANS: A
The HNCT is used to describe the manner of communicating that acknowledges the unique characteristics of the holistic human being.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 115-116
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as:
a. advisement. b. consultation. c. persuasion.
d. suggestion.
ANS: C
Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 112
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. Which of the following is true about negotiation?
a. It commonly results in a win-lose situation.
b. It is aimed at solving problems, conflicts, or disputes.
c. It is used only in contract and labor union disputes.
d. It is the exchanging of favors or trading activity.
ANS: B
Negotiation is used to solve problems, conflicts, or disputes.
DIF: Cognitive Level: Understand (Comprehension) REF: Pages 112-113
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, “You might want to be cognizant of your nonverbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns.” This preceptor is giving advice about:
a. interpersonal communication.
b. clarity.
c. image.
d. intention.
ANS: A
If the verbal message is clear, but the nonverbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse’s nonverbal behavior may suggest that she is not interested in interacting with the family.
DIF: Cognitive Level: Apply (Application) REF: Page 112
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
7. In an all-channel network of communication, the information is sent:
a. from the next person in command to above or below.
b. in any direction without restrictions.
c. from one person, who passes it on to others.
d. from the boss, who sends selected information back.
ANS: B
Organizations using an all-channel structure of communication send information in any direction without restrictions. Usually, an association exists between communication patterns and the organizational structure.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 123
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. Most audience interpretations for speaker messages are determined by the speaker’s:
a. body language and facial expressions.
b. literal words.
c. pitch and volume of speech.
d. vocal quality and tone.
ANS: A
Research has shown that 55% of audience interpretations for speaker messages are determined by the speaker’s nonverbal communication, such as facial expression and body language; 38% by the speaker’s vocal quality, including tone, pitch, volume, and variation; and 7% by the literal words.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 125
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
9. communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction.
a. Defensive
b. Disruptive
c. Negotiating
d. Humanizing
ANS: B
Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 125
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
10. Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n):
a. breach of beneficence.
b. example of maleficence.
c. potential assault and battery charge.
d. violation of the Health Insurance Portability and Accountability Act (HIPAA).
ANS: D
HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient’s privacy in health care transactions. This is an example of breach of confidentiality.
DIF: Cognitive Level: Apply (Application) REF: Page 114
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
11. Interpersonal communication is defined as:
a. the conscious intent by one individual to modify the thoughts or behaviors of
others.
b. a combination of written and spoken communication.
c. a theory used to describe a manner of communicating.
d. communication between two or more individuals involving face-to-face interaction.
ANS: D
Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 115
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
12. Whether it is intentional or not, leaders and managers always communicate their:
a. attitude.
b. power.
c. spirituality.
d. decisions.
ANS: A
Leaders and managers always communicate their attitudes, goals, and expectations. Leaders communicate vision and a sense of where they are going and what they expect from their followers.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 112
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
13. Which communication technique is used to handle patient complaints?
a. Persuasion b. Bargaining c. Negotiation
d. Nonverbal cues
ANS: C
Negotiation is used to educate clients and other professionals about nurses’ roles and contributions, to interact with vendors, and to deal with patient and client complaints.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 113
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
14. Patterns of communication where assertiveness and confrontation are the norm will create a relationship of:
a. congruity.
b. trust.
c. listening.
d. separation.
ANS: D
As one moves to communicate with patterns of interaction that include assertiveness, confrontation, and conflict, perceptions will increasingly differ and ultimately end the relationship in separation.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 116
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
15. Interpersonal communication that recognizes an individual’s human characteristics and addresses the health care issue with dignity and respect is called:
a. dehumanizing.
b. humanizing. c. persuasion. d. bargaining.
ANS: B
To humanize means to recognize the individual's human characteristics and to address the presented health care issues with dignity and respect. To implement the spiritual aspect of holistic health care, concerted effort is needed by health care leaders in both education and practice to guide people in a careful exploration of interpersonal communication processes
that are known to promote humanizing relationships not only between the nurse and client but also between and among health care colleagues.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 119
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
16. Which of the following reported a survey indicating the role that intimidation plays in the safe administration of medications?
a. Workplace Bullying and Trauma Institute
b. Institute for Safe Medication Practices
c. American Nurses Association
d. HNCT
ANS: B
The Institute for Safe Medication Practices reported a survey indicating the role that intimidation plays in the safe administration of medications.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 124
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
1. Effective communication is fostered through which of the following ingredients (select all that apply)?
a. Trust
b. Humility c. Respect d. Empathy
e. Sympathy
ANS: A, C, D
Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 111
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. Which of the following patterns of communication are utilized in HNCT (select all that apply)?
a. Detaching
b. Communing c. Confronting d. Conflicting e. Negotiation
ANS: B, C, D
The communication patterns of interaction are conveyed with an attitude that can be identified on the humanizing–dehumanizing continuum with HNCT. These include communing, asserting, confronting, conflicting, and separating.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 111
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. A client’s wife is concerned about her husband’s declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed “no breathing machine” for long-standing care, but she is unsure of his wishes if he were to need a “breathing
machine” for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client’s physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client’s concerns with the rest of the team. What type of communication technique is being utilized by the nurse (select all that apply)?
a. Bargaining b. Negotiation c. Persuasion
d. Spiritual assessment
e. Collective action
ANS: B, C
Persuasion and negotiation are used to ensure that all members of the team work together in a cooperative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse.
DIF: Cognitive Level: Apply (Application) REF: Pages 112-113
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. Which of the following are examples of patient privacy or security breaches (select all that apply)?
a. Encrypted e-mail communications
b. Fax transmission sent to incorrect physician office
c. Prescription given to patient with wrong label attached
d. Case management coordinator obtaining information about a patient’s diagnosis
e. Discharge summary given to patient’s spouse
ANS: B, C
Fax transmissions sent to the incorrect physician’s office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.
DIF: Cognitive Level: Apply (Application) REF: Page 114
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. During times of extreme crisis, what types of communication can be expected (select all that apply)?
a. Employees prefer to obtain communication from external sources.
b. Normal communication flows are disrupted.
c. Managers should remain at home to decrease the number of personnel on scene.
d. Managers and leaders should stay focused on the business.
e. Managers and leaders have a contingency and disaster plan in place.
ANS: B, D, E
In times of extreme crisis, internal communication to employees takes precedence. It is important for leaders to be on the scene to lead, make decisions, and show compassion. Leaders choose communication channels carefully, because normal flows are often disrupted. Managers stay focused on the business at hand and have a contingency and disaster plan in place.
DIF: Cognitive Level: Apply (Application) REF: Page 114
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. Which of the dimensions of spirituality should nurses be responsible for in care delivery
(select all that apply)?
a. Culture b. Beliefs c. Values
d. Meanings
e. Goals
ANS: B, C, D, E
Although definitions of spirituality are endless, nurses need to be responsible for five dimensions: beliefs, values, meanings, goals, and relationships.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 115
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
7. Numerous theories of communication are in place for use in nursing practice. What are some of the humanizing attitudes that are used in promoting relationships (select all that apply)?
a. Authenticity b. Monologue c. Equality
d. Individual
e. Tolerance
ANS: A, C, D
Authenticity, equality, and individual are attitudes that promote relationships and communication.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 116
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. Situational leadership focuses on three competencies deemed necessary for a leader’s success.
Which of the following are correct statements (select all that apply)?
a. Communicating is a behavioral competency.
b. Communicating is a process competency.
c. Diagnosing is a behavioral competency.
d. Diagnosing is a cognitive competency.
e. Adapting is a behavioral competency.
ANS: B, D, E
Situational leadership focuses on the following three competencies deemed necessary for success. Diagnosing is a cognitive—or cerebral—competency. It is the understanding of what the situation is now and knowing what it can reasonably be expected to be in the future. The discrepancy between the two is the problem to be solved. This discrepancy is what the other competencies are aimed at resolving. Adapting is a behavioral competency. It involves adapting behavior and other resources in a way that helps close the gap between the current situation and what the leader wishes to achieve. Communicating is a process competency. Leaders need to communicate effectively. If leaders cannot communicate in a way that people can understand and accept, they will be unlikely to meet their goals.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 121
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
9. Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness (select all that apply)?
a. Members are organized and secure about their roles in the forming stage.
b. At the forming stage, the group needs direction in defining goals.
c. During the storming period, there is more willingness to accept the group goals.
d. The group becomes self-managing during the norming period.
e. During the performing period, the members willingly perform the task.
ANS: B, C, E
At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self- managing.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 122-123
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
10. Which are characteristics of interpersonal communication (select all that apply)?
a. Communication is unavoidable.
b. Each person has an independent role as sender or receiver of messages.
c. The sender and receiver are dependent in interpersonal communication.
d. Interpersonal communication is the means by which we confirm and validate self.
e. Interpersonal communication is irreversible and unrepeatable.
ANS: A, D, E
Communication is unavoidable and inevitable when people are aware of one another. Each person assumes roles as both sender and receiver of messages in interpersonal communication. In interpersonal communication, the sender and the receiver are interdependent. Interpersonal communication is the means by which we confirm and validate self. Interpersonal communication is irreversible and unrepeatable and almost always functions in a context of change.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 121
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
Chapter 10: Power and Conflict
Test Bank
MULTIPLE CHOICE
1. The transferring of authority, responsibility, and freedom to act and the inspiring of self- confidence is known as:
a. actualization. b. authorization. c. empowerment. d. ratification.
ANS: C
Empowerment is the transfer of actual power and inspiring self-confidence (Kramer & Schmalenberg, 1990).
DIF: Cognitive Level: Understand (Comprehension) REF: Page 161
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. A nurse on a medical-surgical floor has been asked to join a research committee. She agrees to this request because of her great admiration for the vice-president of nursing. This is an example of dimension of power.
a. dependence
b. relational
c. subversive
d. tactical
ANS: B
Relational dimension of power is a property of a social relationship. Dahl (1957) describes power as an interactive process in which “A has power over B to the extent that he can get B to do something B would not otherwise do.”
DIF: Cognitive Level: Apply (Application) REF: Page 160
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. The motivational approach of empowerment is different from the relational approach of empowerment in that it includes more:
a. autonomy in each strategic step.
b. delegation of managerial duties and tasks.
c. emphasis on open communication and goal setting.
d. laissez-faire methods and strategies of persuasion.
ANS: C
The motivational approach of empowerment includes less delegation of power and more emphasis on open communication and inspirational goal setting. The affective domain is emphasized, with feelings of ownership, responsibility, capability, commitment, and involvement.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 161
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. A staff nurse frequently is providing positive comments to get the manager in a good mood before asking about additional vacation time. This influence tactic is known as:
a. consultation.
b. ingratiation.
c. inspiration appeals.
d. rational persuasion.
ANS: B
Ingratiation occurs when the agent uses praise, flattery, friendly behavior, or helpful behavior to get the target in a good mood or to think favorably of him or her before asking for something.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 161
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. Management offers a day of pampering at a spa if nurses agree to work 3 out of 4 weekends over the summer. This type of power is known as:
a. coercive.
b. expert.
c. legitimate.
d. reward.
ANS: D
French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When reward power is used, most people comply because of the positive benefits of doing so.
DIF: Cognitive Level: Understand (Comprehension) REF: Pages 162-163
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as:
a. coercive.
b. expert.
c. legitimate.
d. reward.
ANS: A
French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply.
DIF: Cognitive Level: Apply (Application) REF: Pages 162-163
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
7. Subunit power is derived from:
a. being independent within the organization.
b. providing resources on which the organization most depends.
c. supplying multiple cross-trainable functions within the organization.
d. voicing unique opinions and values within the organization.
ANS: B
Subunit power is derived from providing resources on which the organization most depends. Subunit power also is derived from dependence, coping with uncertainty, being irreplaceable, having the ability to affect the decision process, and having shared consensus within the organizational subunit.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 165
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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