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Interpersonal Relationships Professional Communication Skills for Nurses 7th Edition Boggs Arnold – Test Bank

 

 

Chapter 3: Clinical Judgment and Ethical Decision Making

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. Which of the following types of thinking reflects the nursing process?
a. Habits
b. Inquiry
c. Mnemonic
d. Practice

 

 

ANS:  B

More structured methods of thinking, such as inquiry, have been developed in disciplines related to nursing. Repetitive practice does not reflect the nursing process. Memorizing does not reflect the nursing process.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 40

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following personality characteristics is a barrier to critical thinking?
a. Accepting change
b. Being open minded
c. Stereotyping
d. Going with the flow

 

 

ANS:  C

Stereotyping is a cognitive barrier to critical thinking because it interferes with the ability to treat a client as an individual. Critical thinkers recognize that priorities change continually. Being open minded is the ability to consider alternatives. Being flexible is a bridge to critical thinking, not a barrier.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 46

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The ethical decision-making model where good is defined as maximum welfare or happiness is known as the
a. utilitarian model.
b. human rights based model.
c. duty-based model.
d. Kant’s model.

 

 

ANS:  A

The utilitarian model is also known as the goal-based model, where the duties of the nurse are determined by what will achieve maximum welfare. In the human rights model, the client has basic rights, including the right to refuse care. In the duty-based model, rightness is determined by moral worth. The duty-based model is based on Kant’s philosophy.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 41

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following case examples represents the ethical concept of distributive justice?
a. A famous baseball player receives a heart transplant.
b. An older adult who has government insurance is denied standard cancer treatment.
c. During a visit to his physician’s office, a client demands antibiotics for his cold and is given a prescription.
d. A client suffering from cirrhosis of the liver is placed on a transplant list.

 

 

ANS:  B

The decision to deny expensive treatments or to deny acute care to clients older than a certain age because of scarce treatment resources is an example of the concept of distributive justice. A famous baseball player who receives a heart transplant could be an example of the concept of social worth. A client demanding antibiotics for his cold during a physician’s office visit is an example of the concept of unnecessary treatment. A client who suffers from cirrhosis and who is placed on a transplant list is an example of justice, being fair or impartial.

 

DIF:    Cognitive Level: Analysis               REF:   pp. 43-44

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Personal values are defined as
a. values shaped by family, religious beliefs, and years of experience.
b. altruism.
c. two values that are in conflict.
d. values determined by commitment.

 

 

ANS:  A

We all have a personal value system developed over a lifetime that has been extensively shaped by our family, our religious beliefs, and our years of life experiences. Altruism is a core value of professional nursing. Cognitive dissonance refers to two conflicting values. Value intensity refers to the amount of an individual’s commitment to values.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 46

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A nurse values autonomy and self-determination as well as the preservation of life. This is an example of
a. conceptions of the ideal.
b. cognitive dissonance.
c. operative values.
d. commitment.

 

 

ANS:  B

Cognitive dissonance refers to the mental discomfort felt when there is a discrepancy between what an individual already believes and some new information that does not go along with that view. It refers to the holding of two or more conflicting values at the same time. Conceptions of the ideal are conceived values. Operative values do not refer to conflicting values. Commitment refers to value intensity.

 

DIF:    Cognitive Level: Application          REF:   p. 46

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following statements is true about the critical thinking process?
a. It is a linear process.
b. The skills are inborn.
c. It is goal directed.
d. It assists nurses to criticize the health care system.

 

 

ANS:  C

The process of critical thinking is systematic, organized, and goal directed. As critical thinkers, nurses are able to explore all aspects of a complex clinical situation. Critical thinking is a circular process. Critical thinking is a learned skill that teaches you how to “think about your thinking.” Critical thinking is clinical judgment, not criticism.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 49

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following best describes the critical thinking skills of a novice nurse and an expert nurse?
a. The expert nurse is able to diagnose faster than the novice nurse.
b. The expert nurse does not need to question and reassess like the novice nurse.
c. The novice nurse uses past knowledge, whereas the expert nurse stays in the here and now.
d. The expert nurse organizes data more efficiently than the novice nurse.

 

 

ANS:  D

The novice nurse collects lots of facts but does not logically organize them. Novice nurses tend to jump too quickly to a diagnosis without recognizing the need to obtain more facts. The expert nurse constantly questions and reassesses. The expert nurse compares new information with prior knowledge, while the novice nurse makes fewer connections to past knowledge.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 45

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. A client with schizophrenia has been stabilized on long-acting haloperidol, an antipsychotic medication that is administered by injection every 3 weeks. The physician switches the medication to Seroquel, a new antipsychotic oral medication that is administered twice a day. The client complains that he cannot afford the new medication and will not be able to remember to take it. The physician replies, “I can’t help that; I have to treat you the way I think is best.” The client’s nurse may experience
a. paternalism.
b. cognitive dissonance.
c. nonmaleficence.
d. moral distress.

 

 

ANS:  D

Moral distress results when the nurse knows what is right but is bound to do otherwise because of legal or institutional constraints. Paternalism is making decisions for clients based on what is thought best for them. Cognitive dissonance occurs when there are two conflicting values. Nonmaleficence is avoiding actions that bring harm to another person.

 

DIF:    Cognitive Level: Application          REF:   p. 47

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Characteristics of a critical thinker include all but which of the following?
a. Haphazardly seeking solutions
b. Anticipating consequences
c. Considering alternative solutions
d. Revising actions based on new input

 

 

ANS:  A

This is an example of a negative style question. “Haphazardly seeking solutions” is correct because a characteristic of a critical thinker is to systematically seek solutions, not to haphazardly seek solutions. All of the other options are characteristics of a critical thinker.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 45

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The best method for nurse educators to teach professional values is
a. reading the ANA code.
b. laissez-faire.
c. role modeling.
d. values clarification.

 

 

ANS:  C

Nursing education helps a nurse to acquire a professional value system. In nursing school, the student nurse begins to take on some of the values of the nursing profession. Often, professional values are transmitted by tradition in nursing classes and clinical experiences. They are modeled by expert nurses and assimilated as part of the role socialization process during the years spent as a student and new graduate. Professional values are stated in the ANA code, but the best way to transmit them is by role modeling. Professional values are transmitted by tradition and assimilated in the role socialization process. Values clarification helps a nurse to identify and prioritize values.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 49

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following describes the first step in acquisition of a value?
a. There must be pride in and happiness with the choice.
b. The value must be acted upon in a pattern of behavior consistent with the choice.
c. The value should be the result of conscious choice.
d. The value must be chosen after careful consideration of each alternative.

 

 

ANS:  C

Professional values acquisition should be the result of conscious choice. This is the first step in values acquisition. The value must be acted upon in a pattern of behavior consistent with the choice, which occurs during the seventh criteria for acquisition of a value. Pride and happiness with the choice occurs during the fourth criteria for acquisition of a value. Careful consideration of each alternative occurs during the third criteria for acquisition of a value.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 49

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The client’s values
a. must coincide with those of the nurse.
b. are only considered during assessment.
c. influence the nurse’s interventions.
d. are not influenced by culture.

 

 

ANS:  C

In the planning phase, it is important to identify and understand the client’s value system as the foundation for developing the most appropriate interventions. It is not necessary for the client and nurse’s values to coincide; in fact, it is an unrealistic expectation. The client’s value system is important to consider throughout the nursing process. Values are influenced by culture and religious beliefs.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 51

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Values clarification can be incorporated within the intervention phase of the nursing process by
a. identifying ineffective family coping.
b. identifying care guidelines.
c. identifying client’s values.
d. identifying specific nursing diagnoses.

 

 

ANS:  B

Plans of care that support rather than discount the client’s health care beliefs are more likely to be received favorably. Your interventions include values clarification as a guideline for care. Ineffective family coping is a nursing diagnosis, not an intervention. Values are identified and then used as care guidelines. Nursing diagnosis does not occur during the intervention phase of the nursing process.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 51

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Management of Care

 

  1. During the third step in the critical thinking process
a. new data are obtained.
b. values are clarified.
c. existing information is compared with past knowledge.
d. the problem is identified.

 

 

ANS:  C

During step 3, existing information is compared with past knowledge. New data are obtained in step 4. Values are clarified in step 2. The problem is identified in step 5.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 51

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The student nurse can best learn the steps in critical thinking through
a. reading journals.
b. classroom instruction.
c. repeated practice.
d. developing a mnemonic.

 

 

ANS:  C

The most effective method of learning the steps in critical thinking is by repeatedly applying them to clinical situations. Reading journals, classroom instruction, and developing a mnemonic are not the most effective ways of learning the steps in critical thinking.

 

DIF:    Cognitive Level: Application          REF:   p. 54

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. The bioethical principle of autonomy refers to
a. the client’s right to self-determination.
b. avoiding actions that bring harm to another person.
c. a decision resulting in the greatest good or least harm.
d. being fair or impartial.

 

 

ANS:  A

Autonomy is the client’s right to self-determination. Avoiding actions that bring harm to another person refers to the principle of nonmaleficence. A decision resulting in the greatest good or least harm refers to the principle of beneficence. Being fair or impartial refers to the principle of justice.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 42

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

MULTIPLE RESPONSE

 

  1. Which of the following is true about critical thinkers? (Select all that apply.)

Critical thinkers

a. are open minded.
b. are able to consider alternatives.
c. use a purposeful reasoning process.
d. use a linear thinking process.
e. are able to recognize information gaps.

 

 

ANS:  A, B, C, E

Critical thinkers use specific thinking skills that are not rigid, and these allow the consideration of alternatives and recognition of gaps and available information. Critical thinkers do not use a linear process but constantly add new input.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 45

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

Chapter 11: Bridges and Barriers in Therapeutic Relationships

Arnold: Interpersonal Relationships, 7th Edition

 

MULTIPLE CHOICE

 

  1. Which of the following describes caring?
a. It is difficult to demonstrate professionally.
b. It is an ethical responsibility.
c. It is an intuitive process.
d. It is not influenced by past experience.

 

 

ANS:  B

Caring is an ethical responsibility that guides a health care provider to advocate for the client. Caring is demonstrated professionally in the therapeutic relationship. It is an intentional action that is learned. A person who has received caring is more likely to be able to offer it to others.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 202

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following should be achieved first in establishing the nurse-client relationship?
a. Trust
b. Empathy
c. Mutuality
d. Empowerment

 

 

ANS:  A

Establishing trust is the foundation in all relationships. The development of a sense of interpersonal trust, a sense of feeling safe, is the keystone in the nurse-client relationship. Empathy is used by the nurse after trust is established. Mutuality is important in establishing client goals. Empowerment occurs when the client actively participates in his or her care plan.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 205

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following describes mutual goals?
a. Mutuality is based on client goals.
b. Mutuality is based on interdisciplinary health team goals.
c. Mutuality is based on the nurse’s goals.
d. Mutuality is based on the physician’s goals.

 

 

ANS:  A

Evidence of mutuality is seen in the development of individualized client goals and nursing actions that meet a client’s unique health needs—not on the goals of the health team, the nurse, or the physician.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 206

TOP:   Step of the Nursing Process: Planning

MSC:  Client Needs: Management of Care

 

  1. Which of the following is a violation of client confidentiality?
a. Sharing of information about a communicable disease
b. Stating client’s diagnosis during change of shift report
c. Photographing a client’s wound to monitor the healing process
d. Discussing private information about the client casually with others

 

 

ANS:  D

Discussing private information casually with others is an abuse of confidentiality. It is legal to share information about public health issues such as a communicable disease. Information can be shared with the health care team. Photographing a client’s wound is not a breach of confidentiality; the pictures stay with the client’s record and are used for the benefit of the client.

 

DIF:    Cognitive Level: Analysis               REF:   p. 215

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Stereotypes are learned during
a. exposure to early education.
b. childhood and reinforced by life experiences.
c. limited contact with other cultures.
d. uncomfortable experiences with culturally diverse clients.

 

 

ANS:  B

Stereotypes are learned during childhood and reinforced by life experiences.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 209

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following describes proxemics?
a. Study of relationship between message and topic at hand
b. Study of implied meanings within individuals
c. Study of an individual’s use of space
d. Study of the emotional personal space boundary

 

 

ANS:  C

Proxemics is the study of an individual’s use of space. The study of relationships between messages and topics at hand and the study of implied meanings within individuals do not involve the use of space. An individual can use space as an invisible boundary.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 210

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. Which of the following is a barrier to communication?
a. Intrusion into personal space
b. Unconditional acceptance
c. Self-awareness
d. Gender differences

 

 

ANS:  A

Understanding communication barriers in a relationship (e.g., anxiety, stereotyping, or violations of personal space or confidentiality) affects the quality of the relationship. Unconditional acceptance is an essential element in the helping relationship. Self-awareness enhances communication. No evidence exists showing that gender differences obstruct the therapeutic relationship.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 210

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following is true about trust?
a. The sender feels it.
b. It is difficult to demonstrate professionally.
c. It is an intuitive process.
d. The trusting client feels comfortable revealing needs.

 

 

ANS:  D

The development of a sense of interpersonal trust, a sense of feeling safe, is the keystone in the nurse-client relationship. Trust provides a nonthreatening interpersonal climate in which the client feels comfortable revealing his needs. The sender promotes a trusting relationship. Trust is demonstrated professionally in the nurse-client relationship. The development of trust is based on past experiences, not intuition.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 205

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse demonstrates an understanding of mutuality when stating to the client,
a. “Mr. Jones, I think you should go to bed now.”
b. “Mr. Jones, I would like you to go to bed now.”
c. “Mr. Jones, I don’t think you should sit in the chair.”
d. “Mr. Jones, I thought we agreed that you would return to bed at this time.”

 

 

ANS:  D

Mutuality basically means that the nurse and the client agree on the client’s health problems and the means for resolving them and that both parties are committed to enhancing the client’s well-being. When the nurse instructs the client what to do, it represents the nurse’s goals for the client and does not demonstrate mutuality.

 

DIF:    Cognitive Level: Application          REF:   p. 206

TOP:   Step of the Nursing Process: Interventions

MSC:  Client Needs: Psychosocial Integrity

 

  1. When entering a client’s room, the nurse notices the client standing while wringing her hands and wearing street clothes over pajamas. On further examination, it is noted that the client is hyperventilating with elevated vital signs. Which level of anxiety is the client experiencing?
a. Mild
b. Moderate
c. Severe
d. Panic

 

 

ANS:  C

Signs of severe anxiety include elevated vital signs, impaired problem-solving, and a confused mental state. Signs of mild anxiety are enhanced problem-solving and increased alertness. Signs of moderate anxiety do not include high blood pressure. During panic, the client is immobilized with no cognitive or coping abilities.

 

DIF:    Cognitive Level: Analysis               REF:   pp. 208-209

TOP:   Step of the Nursing Process: Assessment

MSC:  Client Needs: Physiological Adaptation

 

  1. Which of the following situations is an example of the nurse using empathy?
a. Setting up a rehabilitation placement for a client addicted to heroin
b. Sitting quietly and holding a client’s hand while she cries following the news that she has inoperable cancer
c. Giving a bed bath to a client who suffers from a cerebral vascular accident (CVA)
d. Telling a client all about the fun night at one of the local clubs

 

 

ANS:  B

Empathy is the ability to be sensitive to and communicate understanding of the client’s feelings. The client should be encouraged to be involved in his or her own care and to assume responsibility. The nurse should not tell a client about extracurricular activities because this is an example of nontherapeutic self-disclosure by the nurse.

 

DIF:    Cognitive Level: Application          REF:   pp. 205-206

TOP:   Step of the Nursing Process: Implementation

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse knocks on the client’s door and waits for the client to answer before entering the room. The nurse is demonstrating
a. nonverbal communication skills.
b. respect for the client’s personal space.
c. respect for the client’s confidentiality.
d. respect for the client’s gender difference.

 

 

ANS:  B

Giving warning before entering a client’s room demonstrates respect for personal space. Knocking is not a demonstration of nonverbal communication. Knocking at a door before entering the room does not relate to respect for a client’s confidentiality. Respect for a client’s personal space should be demonstrated regardless of gender.

 

DIF:    Cognitive Level: Application          REF:   p. 214

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following is true regarding personal space?
a. Individuals living in a Western culture need 40 square feet of personal space.
b. Direct eye contact causes a need for less space.
c. People need less space when they are anxious.
d. The elderly need more control over their personal space.

 

 

ANS:  D

The elderly need control over personal space because they can become profoundly disoriented in unfamiliar environments. Individuals living in a Western culture need 86-108 square feet of personal space. Direct eye contact causes a need for more space. People need more space when they are anxious.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 210

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following demonstrates the use of the caring process?
a. Respecting the uniqueness of every client
b. Problem solving for the client
c. Performing tasks for the client
d. Communicating expectations of the health care team

 

 

ANS:  A

Caring is described as a commitment by the nurse that involves profound respect and concern for the unique humanity of every client and a willingness to confirm the client’s personhood. Caring is demonstrated by problem-solving with the client, not for the client. Encouraging self-care empowers the client. The nurse needs to respond to the client’s expectations for health care.

 

DIF:    Cognitive Level: Application          REF:   p. 205

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

  1. In order to reduce clinical bias in nursing practice, the nurse should
a. memorize beliefs held by different cultures.
b. generalize beliefs based on ethnic membership.
c. develop a nonjudgmental, neutral attitude.
d. recognize that individuals of the same religion share the same characteristics.

 

 

ANS:  C

Developing a nonjudgmental, neutral attitude toward a client helps the nurse reduce clinical bias in nursing practice. The nurse does not have to memorize beliefs to become culturally sensitive. Stereotypes are generalized beliefs based on ethnic membership. All individuals of a particular social group, race, or religion do not share the same characteristics.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 215

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Management of Care

 

MULTIPLE RESPONSE

 

  1. Which of the following nursing behaviors are included in the levels of nursing actions within Level 1? (Select all that apply.)
a. Confronts conflict
b. Uses client’s correct name
c. Maintains eye contact
d. Adopts open posture
e. Responds to cues

 

 

ANS:  B, C, D, E

Using a client’s correct name, maintaining eye contact, adopting open posture, and responding to cues are responses that are demonstrated by the accepting category within Level 1 of levels of nursing action. Confronting conflict is an example of a nursing behavior at the analyzing category of Levels 4-5.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 213

TOP:   Step of the Nursing Process: All phases

MSC:  Client Needs: Psychosocial Integrity